Trends in emergency department asthma care in metropolitan chicago: Results From the Chicago asthma surveillance initiative

• Published in: Chest Vol. 124; no. 5; pp. 1774 - 1780
• Main Authors: LENHARDT, Richard, MALONE, Anita, GRANT, Evalyn N, WEISS, Kevin B
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01.11.2003; Elsevier B.V
• Subjects: Asthma; Asthma - diagnosis; Asthma - therapy; Biological and medical sciences; Blood Gas Analysis; Bronchodilator Agents - therapeutic use; Care and treatment; Chicago; Chronic obstructive pulmonary disease, asthma; Cross-Sectional Studies; Data Collection; Education; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Emergency Service, Hospital - trends; Evaluation; Glucocorticoids - therapeutic use; Guideline Adherence; Hospitals, Urban; Humans; Medical care; Medical sciences; Oximetry; Patient assessment; Patient Education as Topic; Patients; Pneumology; Polls & surveys; Prevention programs; Quality management; Quality of Health Care - trends; Questionnaires; Response rates; Statistics; Surveillance; Theophylline - therapeutic use; Trends; United States; United States; North America; America; Chicago; United States > US; Chicago Illinois; Human; Urban environment; Respiratory disease; Hospitalization; asthma: emergency; Asthma; Crisis; questionnaires; Lung function; Treatment; guideline adherence; practice guidelines; Respiratory distress; Obstructive pulmonary disease; Emergency; Public health
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.124.5.1774

The purpose of this study was to assess trends in emergency department (ED) asthma care in a single large community and to address how these trends meet expectations of national guidelines for asthma care. This study is based on a repeated cross-sectional, self-administered survey of ED directors (or designees) in the Chicago area. Fifty-one EDs that responded to both the 1996-1997 and 2000 surveys comprise the database for this study. Areas of significant improvement from 1996-1997 to 2000 include reduction in the use of theophylline (10.1% vs 3.1%, p < 0.0001), increased use of systemic steroid prescriptions at discharge (57.7% vs 77.2%, p < 0.0001), decreased use of arterial blood gas (ABG) analyses as part of the initial patient assessment (10.2% vs 4.5%, p = 0.02) and to document improvement after treatments (18.8% vs 8.9%, p = 0.03) and increased use of pulse oximetry as part of the initial patient assessment (95.1% vs 98.1%, p = 0.05). Areas of significant worsening of asthma care from 1996-1997 to 2000 include reduction in the use of ABG analyses in the assessment of severe cases (71.5% vs 47.5%, p < 0.0001), decreased use of instructions to inform patients what to do in the event of inability to attend their follow-up appointment (94.4% vs 38.9%, p = 0.0004), and decreased use of peak expiratory flow rate measurements to document improvement after treatments (82.7% vs 78.6%, p = 0.04). From 1996-1997 to 2000, ED asthma care in metropolitan Chicago has improved in some areas and worsened in others. However, most aspects of asthma care have continued to fall short of national asthma guidelines. The lack of overall improvement with the current widespread knowledge of national guidelines suggests that a dissemination strategy of medical education by itself is not sufficient to improve ED asthma care.