Asthma Care Practices in Chicago-Area Emergency Departments: Discussion
There were also a few differences in the asthma care practice patterns of EDs located in academic vs nonacademic hospitals. The EDs of academic hospitals reported significantly more total ED visits, asthma visits, and ED-to-hospital asthma admissions. The length of visits for patients with asthma was also significantly longer in the EDs of academic hospitals than in the nonacademic hospitals (3.64 h vs 2.86 h; p < 0.05). However, the two groups differed in only two areas of clinical practice. While use of pulse oximetry for initial assessment was frequent overall, use of this technology was higher in the EDs of nonacademic hospitals (97.1% of patients) than in academic hospitals (91.1%; p < 0.05). The EDs of nonacademic hospitals also appeared to be more likely to administer supplemental oxygen than the EDs of academic hospitals (82.3% vs 58.9% of patients; p < 0.01).
The survey results reveal wide variation in many of the asthma-related clinical practice patterns of the Chicago-area EDs. While the data suggest that Chicago-area EDs are providing many of the elements of care that reflect the NAEPP guidelines, there were other practices that are not fully reflective of the guidelines. For example, many of the EDs reported peak flow assessment to be routine care for persons with asthma. However, nearly one in every four EDs reported no use of peak flow measurements for > 25% of asthma patients.
On the other hand, > 95% of patients were reported to have pulse oximetry as part of their assessment, even though the guidelines do not stress oximetry as much as the need for peak flow monitoring.
Another example relates to asthma education, considered a key component of the NAEPP guidelines. The guidelines recommend that discharge education include the following: how to take medications, how to evaluate worsening symptoms, and how to change medication or return for care in the case of worsening symptoms. Education emphasizing the importance of follow-up should also be included. EDs in the Chicago area did not perform well in terms of providing patient education. According to the survey results, approximately two thirds of the patients did not receive any type of formal asthma education from a physician or nurse prior to discharge, and only slightly more than half the patients were discharged with any type of written asthma educational materials. It is not clear why the overall performance with regard to patient education is so poor. Perhaps it is related to the lack of specific goals for educational efforts outlined in the NAEPP guidelines; alternatively, the ED staff may view this as a nonessential element of asthma care.