Pediatric asthma care in the emergency department: Measuring the quality of history-taking and discharge planning

The National Asthma Education and Prevention Program NAEPP Guidelines inclu de recommendations for history-taking and discharge planning during an asth ma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, an d to evaluate the quality of history-taking and discharge planning in the e mergency department (ED) during visits for asthma using the new tool. Exper t opinion and extensive literature review were used to develop a 13-item ch ecklist containing items that should be documented during history-laking an d provided during discharge planning for an ED visit for an acute asthma ex acerbation by children. A convenience sample of 90 pediatric emergency medi cine physicians and allergists rated each item in the checklist. The checkl ist was used to score audiotapes of asthma visits in the ED. Subjects were 154 parents of asthmatic children aged 4-9 years seeking care in nine inner -city EDs affiliated with asthma centers participating in the National Coop erative Inner-City Asthma Study and the physician/providers who delivered c are. Seven of the 13 items on the checklist were rated as required to be pe rformed by more than 90% of the allergist/pediatric emergency medicine phys icians. Only 10% of the 154 visits included all seven of the highly rated i tems, whereas 19% of the visits included three or fewer. Only 7 of the 13 i tems (54%) were performed in more than 50% of the visits, and 4 items were performed in fewer than 25% of visits. Based on expert ratings, the checkli st for measuring elements of history-taking and discharge planning during a sthma visits appears to have considerable face validity. In the visits stud ied, the overall performance of these elements was low. Interventions to im prove performance on the checklist might lead to improved care for children with asthma who frequent the ED.