Asthma Care Practices in Chicago-Area Emergency Departments: Outcome
There is evidence that some of the practice patterns in this study have been observed in other ED settings as well, both in the United States and in other countries. In 1992, Epton et al conducted a chart audit of asthma care in the ED of Christchurch Hospital in New Zealand. The audit revealed peak flow measurement to be common practice, while use of parenteral steroids was less com-mon—a finding similar to other ED audits in Wellington, New Zealand, and in Southampton and Leicester, England. A more recent study of self-reported emergency asthma care conducted by Grunfeld et al in Canada also suggests similar findings.
The CASI survey found admission rates among the Chicago-area EDs to be variable, ranging from 5.4 to 38.5%. ED admission rates (from ED to hospital) are largely a function of the time the patient spends in treatment following steroid administration, and these values reflect differences in length and type of treatment, variations in admission policies, and possibly differences of case-mix severity. This large variation in admission rates suggests that some EDs might be “overadmitting” asthma patients while others may be “underadmitting.” Click Here
A great majority of the respondents—nearly all of whom were the ED medical directors—had heard of the NAEPP guidelines, most had read them, and most rated them as useful. Yet, as the survey results demonstrate, there were variations and shortfalls in clinical care in relation to these guidelines, as well as an overall lack of ED asthma protocols. It is not clear why there is such disparity between the perception of the guidelines as useful and the failure to adopt them into actual practice in the ED. Perhaps the disparity will lessen as more studies are published supporting the use of asthma guidelines for improving patient outcomes.