title: Improving Pediatric Asthma Outcomes in a Community Emergency Department.
abstract: Asthma triggers >775 000 emergency department (ED) visits for children each year. Approximately 80% of these visits occur in community EDs. We performed this study to measure effects of partnership with a community ED on pediatric asthma care.
  
  
  
  For this quality improvement initiative, we implemented an evidence-based pediatric asthma guideline in a community ED. We included patients whose clinical impression in the medical decision section of the electronic health record contained the words asthma, bronchospasm, or wheezing. We reviewed charts of included patients 12 months before guideline implementation (August 2012-July 2013) and 19 months after guideline implementation (August 2013-February 2015). Process measures included the proportion of children who had an asthma score recorded, the proportion who received steroids, and time to steroid administration. The outcome measure was the proportion of children who needed transfer for additional care.
  
  
  
  In total, 724 patients were included, 289 during the baseline period and 435 after guideline implementation. Overall, 64% of patients were assigned an asthma score after guideline implementation. During the baseline period, 60% of patients received steroids during their ED visit, compared with 76% after guideline implementation (odds ratio 2.2; 95% confidence interval, 1.6-3.0). After guideline implementation, the mean time to steroids decreased significantly, from 196 to 105 minutes (P < .001). Significantly fewer patients needed transfer after guideline implementation (10% compared with 14% during the baseline period) (odds ratio 0.63; 95% confidence interval, 0.40-0.99).
  
  
  
  Our study shows that partnership between a pediatric tertiary care center and a community ED is feasible and can improve pediatric asthma care.
authors.affiliation: Children's National Health Systems, Washington, District of Columbia; twalls@childrensnational.org.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Walls
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Naomi T
authors.initials: NT
authors.lastname: Hughes
authors.affiliation: Children's Hospital of the King's Daughters, Norfolk, Virginia.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Mullan
authors.affiliation: Children's National Health Systems, Washington, District of Columbia.
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
authors.affiliation: Children's National Health Systems, Washington, District of Columbia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration; D003430:Cross-Sectional Studies; D004219:District of Columbia; D061345:Early Medical Intervention; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration*; D062606:Tertiary Care Centers
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents