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Changing the process of care and practice in acute asthma in the emergency department: experience with an asthma care map in a regional hospital

Published online by Cambridge University Press:  21 May 2015

Duncan Mackey ,
Marlene Myles ,
Carol H. Spooner ,
Harris Lari ,
Leslie Tyler ,
Sandra Blitz ,
Ambikaipakan Senthilselvan  and
Brian H. Rowe
Duncan Mackey
Affiliation:
Lethbridge Regional Hospital, Lethbridge, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Marlene Myles
Affiliation:
Lethbridge Regional Hospital, Lethbridge, Alta.
Carol H. Spooner
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Harris Lari
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Leslie Tyler
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Ambikaipakan Senthilselvan
Affiliation:
School of Public Health Sciences, University of Alberta, Edmonton, Alta.
Brian H. Rowe*
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta. School of Public Health Sciences, University of Alberta, Edmonton, Alta.
*
Department of Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Health Sciences Center, 8440-112 St., Edmonton AB T6G 2B7; brian.rowe@ualberta.ca

Abstract

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Introduction:

Despite the frequency of acute asthma in the emergency department (ED) and the availability of guidelines, significant practice variation exists. Asthma care maps (ACMs) may standardize treatment. This study examined the use of an ACM to determine its effects on patient management in a regional hospital.

Methods:

Patients aged 2 to 65 years who presented to the ED with a primary diagnosis of acute asthma were enrolled in a prospective study that took place 5 months before (pre) and 5 months after (post) ACM implementation. Research assistants using a standardized questionnaire abstracted data through direct patient interviews and then followed up at 2 weeks with a standardized telephone interview.

Results:

Overall, 71 pre patients and 70 post patients were enrolled. Characteristics in both groups were similar. The care map was used in 100% of the cases during the post period. The mean length of stay in the ED for the pre, compared with the post period, was similar (2 h 14 min v. 2 h 25 min; p = 0.60), as were admission rates (11% v. 9%; p = 0.59). Systemic corticosteroid use was similar (62% v. 57%; p = 0.56); however, the total number of β-agonists (2 v. 4 treatments; p = 0.002) and anticholinergics (1 v. 2 treatments; p < 0.001) administered in the ED was higher during the post period. Prescriptions for oral (73% v. 60%; p = 0.15) and inhaled (78% v. 78%; p = 0.98) corticosteroids at discharge remained the same. Relapse rates at follow-up were unchanged (29% v. 34%; p = 0.52).

Conclusion:

This study provides evidence that implementation of an ACM increased acute bronchodilator use; however, prescribing preventive medications did not increase. Further research is required to evaluate other strategies to improve asthma care by emergency physicians.

Keywords

asthmacorticosteroidspreventionguidelines
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 5 , September 2007 , pp. 353 - 365
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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