title: Changing the process of care and practice in acute asthma in the emergency department: experience with an asthma care map in a regional hospital.
abstract: BACKGROUND
  Despite the frequency of acute asthma in the emergency department (ED) and the availability of guidelines, significant practice variation exists. Asthma care maps (ACMs) may standardize treatment. This study examined the use of an ACM to determine its effects on patient management in a regional hospital.
  
  
  METHODS
  Patients aged 2 to 65 years who presented to the ED with a primary diagnosis of acute asthma were enrolled in a prospective study that took place 5 months before (pre) and 5 months after (post) ACM implementation. Research assistants using a standardized questionnaire abstracted data through direct patient interviews and then followed up at 2 weeks with a standardized telephone interview.
  
  
  RESULTS
  Overall, 71 pre patients and 70 post patients were enrolled. Characteristics in both groups were similar. The care map was used in 100% of the cases during the post period. The mean length of stay in the ED for the pre, compared with the post period, was similar (2 h 14 min v. 2 h 25 min; p = 0.60), as were admission rates (11% v. 9%; p = 0.59). Systemic corticosteroid use was similar (62% v. 57%; p = 0.56); however, the total number of beta-agonists (2 v. 4 treatments; p = 0.002) and anticholinergics (1 v. 2 treatments; p < 0.001) administered in the ED was higher during the post period. Prescriptions for oral (73% v. 60%; p = 0.15) and inhaled (78% v. 78%; p = 0.98) corticosteroids at discharge remained the same. Relapse rates at follow-up were unchanged (29% v. 34%; p = 0.52).
  
  
  CONCLUSIONS
  This study provides evidence that implementation of an ACM increased acute bronchodilator use; however, prescribing preventive medications did not increase. Further research is required to evaluate other strategies to improve asthma care by emergency physicians.
authors.affiliation: Lethbridge Regional Hospital, Lethbridge, Alberta, Canada.
authors.forename: Duncan
authors.initials: D
authors.lastname: Mackey
authors.forename: Marlene
authors.initials: M
authors.lastname: Myles
authors.forename: Carol H
authors.initials: CH
authors.lastname: Spooner
authors.forename: Harris
authors.initials: H
authors.lastname: Lari
authors.forename: Leslie
authors.initials: L
authors.lastname: Tyler
authors.forename: Sandra
authors.initials: S
authors.lastname: Blitz
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011446:Prospective Studies