Effect of an emergency department asthma program on acute asthma care.
OBJECTIVE
To examine the effect of an emergency department program on acute asthma care.


METHODS
We conducted a before-after study of an acute asthma quality improvement initiative in an urban teaching hospital with 65,000 annual ED visits. In mid-1994, a multidisciplinary group identified deficiencies in acute asthma care, developed and implemented a local version of the National Asthma Education Program's practice guidelines (including a standard asthma order sheet), and provided new peak flow (PF) meters. The "before" group comprised all adults with acute asthma seen during January 1994 (n=51); "after" groups comprised all adults with acute asthma seen during October 1994, February 1995, and June 1995 (n=145). Data were compared across months using a nonparametric test for trend.


RESULTS
Although patient demographic characteristics and asthma severity were similar across months, ED process of care significantly changed. Initial PF measurements were obtained in 20% of patients before intervention, compared with 82%, 84%, and 83% during the postintervention months ( P for trend <.001). Follow-up PF readings were obtained in 22%, 70%, 78%, and 62% ( P <.001). Median delays to beta-agonist and steroid therapy decreased by approximately 16 minutes ( P <.001) and 34 minutes ( P =.04), respectively. Outcomes improved, with median ED length of stay decreasing by 58 minutes ( P =.01), and fewer inpatient admissions ( P =.05); there was no significant change in 4-week relapse to our hospital.


CONCLUSIONS
A guideline-based ED asthma program changed clinical practice and improved acute asthma care in a sustained fashion. The effect of this intervention on cost and other outcomes is uncertain.
Emond
S D
SD
Department of Emergency Medicine, New York-Presbyterian Hospital, New York, NY, USA. semond1@idt.net
Woodruff
P G
PG
Lee
E Y
EY
Singh
A K
AK
Camargo
C A
CA
D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010366:Peak Expiratory Flow Rate; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D018709:Statistics, Nonparametric; D013256:Steroids; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*
D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D013256:Steroids