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Canadian Respiratory Journal
Volume 15 (2008), Issue 1, Pages 20-26
http://dx.doi.org/10.1155/2008/431390
Original Article

Increasing the Use of Anti-Inflammatory Agents for Acute Asthma in the Emergency Department: Experience with an Asthma Care Map

Brian H Rowe,1,2 Anthony M Chahal,3 Carol H Spooner,1 Sandra Blitz,1 Ambikaipakan Senthilselvan,2 Deborah Wilson,4 Brian R Holroyd,1 and Michael Bullard1

1Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
2Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
3Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
4Alberta Medical Association Toward Optimized Practice Program, Edmonton, Alberta, Canada

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

PURPOSE: Acute asthma is a common emergency department (ED) presentation and variation in its management is well recognized. The present study examined the use of an asthma care map (ACM) in one Canadian ED to improve adherence to acute asthma guidelines, emphasizing the use of systemic corticosteroids (SCSs) and inhaled corticosteroids (ICSs).

METHODS: Three time periods were studied: the 15 months before ACM introduction (PRE), the 15 months following a three-month introduction of the ACM (POST1) and the 18 months after POST1 (POST2). Randomly selected patient charts from each period were included from patients who were 18 to 60 years of age and presented with a primary diagnosis of acute asthma. A priori criteria were established to determine the degree of completion and success of the ACM. Primary outcomes included documentation, use of SCSs in the ED, and prescription of SCSs and ICSs at ED discharge.

RESULTS: A total of 387 patient charts were included (PRE, n=150; POST1, n=150; POST2, n=87). Patient characteristics in the three groups were similar; however, patients in POST1 and POST2 showed higher use of newer agents than those in the PRE group. Overall, more women (n=209; 54%) than men were seen; the mean age was 32.4 years. The care map was used in 67% of cases during POST1 and 70% during POST2. The use of peak expiratory flow (PEF) was high during the PRE, POST1 and POST2 periods (91%, 89% and 91%, respectively); however, documentation of other markers of severity increased in the POST periods. Use of SCSs occurred earlier (P<0.01) and more often (57% PRE, 68% POST1 and 75% POST2; P<0.01) in the POST1,2 periods than the PRE period. There was a significant increase in use of SCSs on discharge (55% PRE, 66% POST1 and 69% POST2; P<0.05), and prescription of ICSs significantly increased (24% PRE, 45% POST1 and 61% POST2; P<0.001) in the POST1,2 periods. Discharge with-out any corticosteroids decreased over the three periods (32% PRE, 21% POST1 and 17% POST2; P<0.05). The length of stay in the ED increased over the study periods (181 min PRE, 209 min POST1 and 265 min POST2; P<0.01) and admissions were infrequent (9% PRE, 13% POST1 and 6% POST2; P=0.50).

CONCLUSIONS: The present study provides evidence that the standardized ED ACM was widely accepted, improved chart documentation, improved some aspects of ED care and increased prescribing of discharge preventive medications.