title: Education and a standardized management protocol improve the assessment and management of asthma in the emergency department.
abstract: OBJECTIVE
  To evaluate the effect of a standardized management protocol on acute asthma care in the emergency department (ED).
  
  
  METHODS
  We conducted a before-after study regarding acute asthma management. Deficiencies in acute asthma care over a time period of 19 month (January 1997- October 1998) were identified. Subsequently a management protocol consisting of an assessment sheet and written guidelines for the initial management of acute asthma in the emergency department, was developed. In addition, physicians and nurses of the emergency department were informed about the recommendations given in the guidelines, and instructed in peak-flow meter use. The assessment sheet was introduced in January 2002 and posted at several locations in the emergency department. Between February 2002 and August 2003 the acute asthma consultations in the emergency department were consecutively registered. Data on medical history, physical examination and objective measurements of airflow obstruction, as well as data on treatment and assessment of the response to therapy were collected. In addition, medication and instructions at discharge were reviewed and compared with the results before the introduction of the assessment sheet.
  
  
  RESULTS
  The first group consisted of patients seen between January 1997 and October 1998; the second group consisted of all patients seen between February 2002 and August 2003 (104 vs 273 patients respectively). Both groups had a similar gender distribution (56% females in the first group vs 53% females in the second group) and the mean age of both groups was also alike (median 33 vs 36 years). Most patients had a known history of asthma (76% in the first group vs 70% in the second group). The self-referral rate was high in both groups (86% vs 96% respectively). Blood pressure and pulse rate were reported in the majority of patients (95% vs 98% respectively), whereas the respiratory rates were reported in 14% of patients in the first group vs 65% of patients in the second group. The introduction of the assessment sheet led to an increased measurement of initial airflow obstruction (53% of patients in the first group vs 96% of patients in the second group) as well as repeated measures under treatment (36% of patients in the first group vs 85% of patients in the second group). Repeated inhalations with short-acting inhaled beta-agonists, and use of systemic corticosteroid therapy at admission and at discharge increased significantly (from 31% to 84%, 43% to 68% and 37% to 70% respectively).
  
  
  CONCLUSIONS
  The assessment and management of patients presenting to the emergency department with acute asthma can be improved with a guideline based management protocol, and by educating physicians and nurses in the management of acute asthma.
authors.affiliation: Department of Internal Medicine, Medical Policlinic, University Hospital of Zurich, Switzerland. claudia.stey@usz.ch
authors.forename: Claudia
authors.initials: C
authors.lastname: Steurer-Stey
authors.forename: Ursula
authors.initials: U
authors.lastname: Grob
authors.forename: Sabine
authors.initials: S
authors.lastname: Jung
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Vetter
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002985:Clinical Protocols; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents