Asthma Patients In Emergency Department Research Articles

Analysis of medication patterns for pediatric asthma patients in emergency department: Does the sequence placement of glucocorticoids administration matter?

Objectives: Timely glucocorticoid administration is associated with decreased admission rate and is thus a common quality metric for ED asthma care; less is known about the impact of the timing of glucocorticoids in the context of the sequence of asthma medications administered. Therefore, we investigated the distribution of asthma medication sequences in one ED and analyzed the effect of the sequence placement of glucocorticoids administration on treatment outcomes.Methods: A retrospective study using five-year electronic health record data obtained from an academic urban children’s hospital ED was conducted. We clustered the sequences of medication administration using an exact string-matching algorithm to identify the most frequently used asthma medication sequences. Then, we used the identified patterns to perform statistical tests to examine the effect of the sequence placement of glucocorticoids administration on the outcomes length-of-stay and ED disposition.Results: A total of 4,844 encounters were included in our study. The ten most common treatment sequences accounted for 43% of all encounters. Stratified analyses confirmed that treatment sequences pattern was correlated with patient severity, but ED crowding does not impact treatment sequences. In multivariable models, glucocorticoids administration earlier in the treatment sequence was associated with shorter length of stay and lower hospital admission rates.Conclusions: By analyzing medication sequence patterns for the ED encounter of pediatric asthma, we found that the earlier sequence placement of glucocorticoids administration is associated with improved outcomes. Our findings can help inform quality improvement and clinical guideline development related to ED asthma care for children.

A Successful Effort to Improve Asthma Care Outcome in an Inner-City Emergency Department

The purpose of this study was to improve asthma care and outcome in an inner-city emergency department. Consecutive adult patients (19,802) presenting with the diagnosis of acute asthma exacerbation to an inner-city municipal hospital emergency department, between July 1991 and December 1993, were prospectively evaluated. These patients were compared to a historical control group of 7923 consecutive asthma emergency department patients presenting in the year prior to our intervention. An asthma treatment guideline was implemented through a continuous quality improvement process. Asthma relapse rate and admission rate were obtained before and after the guidelines were instituted. Data after interventions were also prospectively compared to asthma outcomes at all other New York City municipal hospital emergency departments. After intervention, mean monthly asthma relapse rates showed a significant reduction from 12.18% to 7.83% (p < 0.001). A similar decrease was also noted in the monthly asthma admission rate, from 4.85 to 3.90 per 100 emergency department visits (p < 0.05). Asthma treatment guidelines along with continuous quality improvement techniques can significantly improve the outcome of inner-city emergency department asthma patients.