Asthma Care Practices in Chicago-Area Emergency Departments: Conclusion
There are at least two studies suggesting that guidelines, once translated into critical pathways for asthma treatment, may improve care. In a United States study by Goldberg et al, approximately 150 patients enrolled in an ED asthma critical pathway (based on the national guidelines) were compared retrospectively to a group of similar patients who were not in a critical pathway. The study found that the processes of care were improved for patients treated via the critical pathway (eg, the patients were treated with IV steroids and given oral steroids at discharge). Another study from New Zealand, by Town et al, suggests that introduction of a guideline-based asthma protocol similarly influenced the management of asthma in the ED.
This study has several limitations. First, the study was based on self-reported perceptions of the medical directors of the EDs; the responses were not verified by direct observation or chart audit. While it is reasonable to expect that the ED medical director was the best person to respond to the survey, within any of the institutions surveyed there might have been a more optimal person to query regarding this specific topic. Also, many of the EDs were unable to supply health-care utilization statistics, which, in turn, produced an unknown set of response biases to these items. This also highlights the overall suboptimal capacity for simple administrative data retrieval for this large group of EDs. canadian family pharmacy
Even considering these limitations, this survey provides, for the first time, a characterization of the variations in asthma care practice patterns as reported by the EDs serving a large metropolitan community. It is this particular strength, and the community-based nature of this data, that has been useful in convening many of the EDs in the Chicago area to begin a collaborative effort to improve the overall quality of asthma care for this com-munity.