Discharge patterns of patients with asthma from the emergency department: a retrospective review.
BACKGROUND
Despite evidence that specific therapies improve outcomes in patients with asthma, they are often not used. Combining several evidence-based therapies into a treatment "bundle" to be offered at the time of discharge from the emergency department, might reduce variation and potentially optimize clinical outcomes.


OBJECTIVE
To assess the utilization of four evidence-based therapies for asthma by analyzing the visits of patients with acute exacerbations of asthma discharged from the emergency department.


METHODS
A retrospective chart review.


METHODS
Single 650-bed inner-city hospital emergency department.


METHODS
Two hundred and twenty six patients discharged from the emergency department after 500 acute exacerbations of asthma.


METHODS
All visits were reviewed for the presence of the four evidence-based components of asthma treatment upon discharge: follow-up referral, oral steroids, asthma education, and inhaled corticosteroids. Visits were also assessed for medications prescribed upon discharge, medication history, and patient's asthma severity based on national guidelines.


RESULTS
The four components of asthma treatment were documented as follows: follow-up referral (86.2%), oral steroids (67.8%), asthma education (19.6%), and inhaled corticosteroids (16.2%). Only 3.4% of visits documented all four components in the aggregate. Twenty-three distinct combinations of medication were prescribed upon discharge. The majority of visits failed to document asthma severity.


CONCLUSIONS
This retrospective chart review reveals significant variation in the discharge management of patients with asthma, specifically regarding medications prescribed. While follow-up referral was sufficiently documented, the remaining three components were not. With only 3.4% of visits containing all four components, implementing an asthma "bundle" may present an opportunity to improve outcomes in asthma management.
Salerno
Edward L
EL
University of Connecticut Health Center, Farmington, USA. elsalerno@yahoo.com
Wolf
Scott
S
Troy
Patrick
P
Horowitz
Sheryl
S
Banever
Abigail
A
Metersky
Mark
M
Shore
Eric
E
D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000628:therapy; D003237:Connecticut; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014504:Urban Health