Medical audit on asthma in an emergency department.
BACKGROUND
To determine the management of acute bronchial asthma in an adult emergency department.


METHODS
A retrospective medical audit of 46 consecutive adult patients with acute asthma exacerbations was performed. We collected information from 48 episodes of acute asthma over a 5-month period. Using classical audit methodology, four indicators were examined: severity evaluation, diagnostic tests, specific treatment, and discharge treatment plans.


RESULTS
The least recorded severity indicators were respiratory rate (27 %), heart rate (50 %) and peak expiratory flow (20 %). Heart and respiratory auscultation were recorded in all patients and oxygen saturation was recorded in 93 %. Laboratory blood test and chest radiograph were performed in all patients. Arterial blood gas was tested in 57 %, electrocardiography in 17 %, and coagulation in 39 %. No treatment was provided in 12 % of patients. Bronchodilator medications were administered in all treated patients and oxygen was prescribed in 60 %. Systemic corticosteroids (methylprednisolone or hydrocortisone) were administered in 80 % of treated patients. Seventeen percent of patients were discharged from hospital with no change to their usual treatment.


CONCLUSIONS
The following weak points were identified: 1) Severity assessment is inadequate, 2) use of diagnostic tests is excessive, 3) patients discharged to home with no treatment plan. Opportunities for improvement consisted of: 1) greater availability of peak expiratory flow meters, 2) individualized use of diagnostic tests, and 3) management protocols.
Linares
T
T
Servicio de Alergia, Hospital Universitario La Fe, Avda. Campinar 21, 46009 Valencia, Spain.
Campos
A
A
Torres
M
M
Reyes
J
J
D000208:Acute Disease; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D010351:Patient Discharge / Q000706:statistics & numerical data; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000628:therapy; D011859:Radiography; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
D018927:Anti-Asthmatic Agents