A tool to organize instructions at discharge after treatment of asthmatic children in an emergency department

Asthma exacerbations continue to be a major cause of visits to emergency de partments (ED). Comprehensive care in the outpatient setting, with planning for early intervention for exacerbations, can reduce emergency visits. Thu s, a major goal of ED intervention is to establish a link between the patie nt and the provider of ongoing asthma care, where complete education can be achieved and reinforced over time. When designing the Asthma 1-2-3 Plan di scharge teaching tool for the ED, consideration was given to educational fo rmat, readability, patient population, and setting in which education was t o be delivered. To evaluate use of the plan, ED records of patients enrolle d in a separate asthma study, the Neighborhood Asthma Coalition (NAC), were audited for two 8-month intervals, May-December 1993 (before initiation of the plan) and May-December 1994 (starting 1 month after completion of pilo t testing on the plan in the ED). To evaluate effectiveness of the plan, re cords of physicians who cared for children in the NAC were evaluated. The d atabase was reviewed for the dale of the first visit for planned review of asthma that occurred after the acute asthma ED visit. After introduction of the plan, the proportion of children told to return to the physician for f ollow-up increased from 54% to 81%. The proportion of children given advice to return to their physician within the recommended 3 days or less increas ed from 11% to 54%. chi(2) Analyses showed that these changes were both sta tistically significant (p < 0.0001). The plan was not effective in achievin g increased follow-up visits for regular asthma care, in that 7% returned f or follow-up within 7 days after an ED visit before the plan and only 6% re turned for such a visit after the Plan. Successful initiation of a focused discharge teaching tool into the routine of the ED increased appropriate ad vice given at lime of discharge from the ED. Although unsuccessful in incre asing appropriate follow-up, the present intervention uses the ED not as a base for asthma education, but as a point for contacting patients in need o f regular care and education, and for promoting access to that regular care .