MANAGING ASTHMA IN ACCIDENT AND EMERGENCY DEPARTMENTS - AN ASSESSMENTIN NONTEACHING HOSPITALS

Background. The management and follow-up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals. Aims: To st udy the adequacy of assessment, treatment and follow-up of patients pr esenting at A&E departments in non-teaching hospitals. To compare the assessment and management of asthma in A&E departments among hospitals in a health region. Methods: A twenty-five per cent sample of present ations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demograph ics, assessment, management and referral was extracted from the A&E ca se notes and medical records of cases with documentation of a final di agnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals. Results: Of 359 presentations with a fina l diagnosis of asthma, 88% were self referred and only 5% were first p resentations. Objective measures of airways obstruction was not docume nted in 34% of admissions and 48% of nonadmissions. There was no docum ented follow-up in 28% of cases. The assessment and management of asth ma in A&E was significantly poorer in smaller hospitals. Conclusion: E vidence of high use of A&E as a primary care facility by asthma patien ts was found in the study. There is a need to implement protocols to o ptimise assessment and treatment of asthma in smaller hospitals.