Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre-school wheeze action plans.
OBJECTIVE
To measure the long-term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre-school wheeze action plan in our population.


METHODS
A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record.


RESULTS
Two thousand three hundred and forty-two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1-15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P < 0.001. These results justified the design of the electronic pre-school wheeze action plan.


CONCLUSIONS
The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan.
Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia. fenton.oleary@health.nsw.gov.au.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. fenton.oleary@health.nsw.gov.au.
Fenton
F
O'Leary
Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Ioannis
I
Pegiazoglou
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Tracey
T
Marshall
Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Deepali
D
Thosar
Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Mitchell
M
Deck
Australian Catholic University, Sydney, New South Wales, Australia.
Jennifer
J
Peat
Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Joanna
J
Ging
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Hiran
H
Selvadurai
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D003430:Cross-Sectional Studies; D004282:Documentation / Q000592:standards / Q000706:statistics & numerical data; D057286:Electronic Health Records; D004632:Emergency Medical Services; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010347:Patient Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies
asthma; child; education; pre-school; quality improvement