Format

Send to

Choose Destination
Chest. 2009 Mar;135(3):724-736. doi: 10.1378/chest.08-0371. Epub 2008 Nov 18.

Variations and gaps in management of acute asthma in Ontario emergency departments.

Author information

1
Queen's University, Kingston, ON, Canada; Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada. Electronic address: mdl@queensu.ca.
2
William Osler Health Centre, Brampton, ON, Canada.
3
University of Toronto, Toronto, ON, Canada.
4
University of Ottawa, Ottawa, ON, Canada.
5
Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada.
6
Queen's University, Kingston, ON, Canada.
7
McMaster University, Hamilton, ON, Canada.
8
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
9
University of Western Ontario, London, ON, Canada.

Abstract

BACKGROUND:

Variation in hospitalization rates for acute asthma in Ontario may reflect gaps between evidence and current emergency department (ED) management. We investigated ED management of asthma and differences in practice patterns for pediatric (< 20 years old) and adult (> or = 20 years old) patients in Ontario EDs.

METHOD:

Patient characteristics and ED management during a 1-year period were assessed by questionnaire and chart abstractions in a stratified sample of 16 Ontario hospitals. Variation between sites was assessed by one-way analysis of variance, Kruskal-Wallis test, or chi(2) test.

RESULTS:

Reported results are based on the first of 2,671 pediatric (42.0% female) and 2,078 adult (66.7% female) visits with a corresponding questionnaire. Asthma severity, comorbidities, access to care, and prehospital management varied significantly among sites (all p < 0.001). Documentation of peak expiratory flow (27.2% of pediatric [age > or = 7] and 44.3% of adult charts), use of systemic steroids in ED (35.2% pediatric and 33.0% adult charts) and on discharge (31.7% pediatric and 33.2% adult charts), and referrals to asthma services (2.8% pediatric and 2.7% adult charts) varied among sites (all p < 0.001). Admission (%) was directly related to time to receive systemic steroids in ED in adults (r = 0.76; p = 0.004). Repeat ED visits (%) were inversely related to new inhaled steroid prescription on discharge in adults (r = -0.64; p = 0.02).

CONCLUSIONS:

Knowledge translation initiatives are warranted to increase adherence with best practices in emergency management of asthma (such as objective assessment of airflow rates, use of systemic steroids, and referrals) in order to reduce variations in care and improve outcomes of severe acute asthma.

PMID:
19017869
DOI:
10.1378/chest.08-0371
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center