[Asthma management in adult emergency departments in Israel in comparison to asthma guidelines].
BACKGROUND
Asthma management is in focus all over the world. It is constantly updated, including aspects of Emergency Department (ED) care, on the basis of global and national evidence-based clinical guidelines. Despite the existence of these guidelines, the management of asthma, including management in the ED, is lagging behind.


OBJECTIVE
This study strives to evaluate various aspects of asthma management in the EDs in Israel.


METHODS
A questionnaire was sent to each Head or Deputy Head of all the adult EDs in Israel. The questionnaires were collected within 16 days in December 2000. Ninety-six percent of all adult EDs in Israel responded. The mean response of each ED to all the questions was 99.5%.


RESULTS
Oximetry on admission is performed for every patient in a third of the EDs although an oximeter is available in every ED. Measurements of airway obstruction severity by PEFRm or FEV1 in more than 50% of patients before hospital admission or discharge is only conducted in 9% of the EDs and in 52% of them it is not measured at all. Inhalation of a short beta-agonist combined with anticholinergic is performed in 84% of EDs. Corticosteroids are given to more than 80% of the arriving patients in only 54% of EDs and on discharge it is continued in all or almost all patients in 63% of EDs. A written time interval for the next medical visit after discharge from ED is not specified in 50% of EDs. In contrast to these findings, there is almost complete accordance among EDs (88%) that asthma management in the ED should follow formal guidelines and that common guidelines for asthma management should be adopted by all EDs in Israel (71%).


CONCLUSIONS
The discrepancies between the existing clinical guidelines for asthma management in the ED and its actual use on the one hand, and the agreement among EDs on the importance of the guidelines on the other hand, are raising the necessity for common guidelines for asthma management in the EDs in Israel. Perhaps, more importantly, it highlights the urgent need for new effective and creative ways to implement asthma guidelines into routine ED practice.
Varsano
S
S
Asthma Care and Education Unit, Pulmonary Medicine Department, Sapir Medical Center Meir Hospital, Kfar Saba Sackler Faculty of Medicine, Tel Aviv University, Israel.
D000328:Adult; D001249:Asthma / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D007557:Israel; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care