269 Impact of an Asthma Care Pathway on the Emergency Department Management of Asthma

Abstract

Introduction of care pathways has been theorized to improve adherence to evidence-based guidelines and improve quality of care metrics. In 2014, an interprofessional team developed and implemented an evidence-based asthma care pathway, including a nursing medical directive and pre-printed order set, supported with education. We sought to assess performance in quality markers of asthma care such as time to corticosteroids and the rational use of diagnostic studies in line with published national and international guidelines for emergency department (ED) management of asthma. A retrospective review of ED patients greater than 16 years of age with a discharge diagnosis of asthma was conducted pre- (September 2013 through March 2014) and post-intervention (April 2014 through January 2015). Measures were: use of peak-expiratory flow rate testing (PEFR), chest x-ray (CXR) performance, and time-based outcomes from triage: time to inhaled beta-agonist therapy, time to inhaled anticholinergic therapy, time to steroid administration, length-of-stay (LOS) and use of pre-printed orders (PPO). A total of 495 cases met criteria (pre-intervention N=290 and post-intervention N=205). Improvements were seen for both time based metrics (median, range) and percent utilization of diagnostic testing after the intervention. Pre- and post-intervention groups showed respectively; PEFR performed (23% vs 45%), CXR performed (30% vs 23%), median time-to-inhaled beta-agonist (44 minutes, 233) vs 38 minutes, 505), median time to inhaled anticholinergic therapy (40 minutes, 233) vs 30 minutes, 266), median time to steroid administration (105 minutes, 414 vs 91.5 minutes, 502), and median LOS (206 minutes, 1320 vs 184.5 minutes, 884). PPO use in the post-intervention group was 4.4%. The implementation of an asthma care pathway, despite infrequent use of the PPO component of the pathway at our institution, appears to have led to an improvement in quality measures of ED asthma care. Opportunities for further improvements may be attained through ongoing provider education and increased protocol adherence.