Quality of asthma care varies significantly in emergency departments
Research Activities, June 2009, No. 346
Approximately 2 million visits to emergency departments (EDs) each year are due to asthma, yet, little is known about the quality of acute asthma care at the ED level. In a new study, researchers have discovered geographic differences in quality of asthma care, with EDs in the South less likely to deliver guideline-specific care. The researchers retrospectively reviewed medical charts related to 6,065 ED visits for acute asthma in 63 urban EDs located in 23 States. They determined just how well such care matched asthma management guidelines issued by the National Institutes of Health.
Emergency departments with higher asthma patient volume tended to score better when it came to delivering guideline-concordant care. This was also true for EDs that had an emergency medicine residency program. The most significant finding, however, was that EDs located in the South were less likely to deliver guideline-concordant care compared with northeastern EDs. Three-quarters of patients (76 percent) studied received all four types of care recommended by the NIH guidelines. Such patients had a significantly lower risk of hospital admission compared with patients who did not receive all four types of care.
More than half of patients treated in the ED for asthma never received any peak expiratory flow (PEF) measurement, a simple measure of breathing capacity. Also, 22 percent of patients may have benefited from receiving systemic corticosteroid therapy if they had received it. Unnecessary antibiotics were given to 17 percent of patients. The researchers also found important delays in the delivery of asthma care in the ED. All of these areas should be the focus of future quality improvement efforts, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13099).
See "Quality of care for acute asthma in 63 US emergency departments," by Chu-Lin Tsai, M.D., Sc.D., Ashley F. Sullivan, M.S., M.P.H., James A. Gorden, M.D., M.P.A., and others, in the February 2009 Journal of Allergy and Clinical Immunology 123(2), pp. 354-361.