Asthma care practices in Chicago-area emergency departments

Introduction: Emergency departments (EDs) represent an important source of asthma care, vet there are few studies detailing how ED asthma practices va ry and to what extent EDs meet expectations of national asthma guidelines. The purpose of this study is to characterize ED care for persons with asthm a in a single large community. Methods: During 1996 and 1997, a cross-sectional, self-administered sun ey to characterize asthma care practices was conducted among medical directors of the 89 EDs serving the Chicago metropolitan area (six counties), The su rvey topic areas included asthma-specific demographics and selected utiliza tion statistics; assessment practices; treatment practices; discharge and f ollow-up activities; and familiarity with, attitudes toward, and utilizatio n of guidelines/protocols. Results: Sixty-four EDs completed surveys, for a response rate of 71.9%. Ni nety-four percent of the respondents were ED medical directors. As part of assessment, peak flow measurements, while common, were used less frequently than pulse oximetry. The average (+/- SE) estimated length of stay for ast hma care was 3.0 +/- 0.1 h, and average disposition time (ie, the decision to admit) was 2.5 +/- 0.2 h, Systemic steroids (either IV or po) were estim ated to be given to 73.2 +/- 3.9% of patients during their ED visits, Syste mic steroids were prescribed for 55.9 +/- 3.5% of patients at time of disch arge. Only 57.0 +/- 5.4% of patients were estimated to have received an, ty pe of written asthma educational materials. Approximately 25% of patients w ere reported to have been given a detailed follow-up appointment at the tim e of discharge. Conclusion: The results reveal that the medical directors reported many of the Chicago-area EDs as providing asthma care that is consistent with key a spects of national guidelines. However, in certain critical areas of care, the EDs demonstrate a high degree of variation, often with the community fa lling short of guideline recommendations. By identifying these variations i n asthma care, it is now possible to target specific goals for community-wi de asthma quality improvement among the EDs in the Chicago metropolitan are a.