Effect of an emergency department asthma program on acute asthma care

Study objective: To examine the effect of an emergency department program o n acute asthma care. Methods: We conducted a before-after study of an acute asthma quality impro vement initiative in an urban teaching hospital with 65,000 annual ED visit s. in mid-1994, a multidisciplinary group identified deficiencies in acute asthma care, developed and implemented a local Version of the National Asth ma Education Program's practice guidelines (including a standard asthma ord er sheet), and provided new peak flow (PF) meters. The "before" group compr ised ail adults with acute asthma seen during January 1994 (n=51); "after" groups comprised all adults with acute asthma seen during October 1994, Feb ruary 1995, and June 1995 (n=145). Data were compared across months using a nonparametric test for trend. Results: Although patient demographic characteristics and asthma severity w ere similar across months, ED process of care significantly changed. Initia l PF measurements were obtained in 20% of patients before intervention, com pared with 82%, 84%, and 83% during the postintervention months (P for tren d <.001). Follow-up PF readings were obtained in 22%, 70%, 78%, and 62% (P< .001). Median delays to beta-agonist and steroid therapy decreased by appro ximately 16 minutes (P<.001) and 34 minutes (P=.04), respectively. Outcomes improved, with median ED length of stay decreasing by 58 minutes (P=.01), and fewer inpatient admissions (P=.05); there was no significant change in 4-week relapse to our hospital. Conclusion: A guideline-based ED asthma program changed clinical practice a nd improved acute asthma care in a sustained fashion. The effect of this in tervention on cost and other outcomes is uncertain.