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Pediatric Tertiary Care Guidelines Improve Community ED Care of Asthma

WASHINGTON, DC – The statistics will come as little surprise to medical staff working in emergency departments (EDs) that treat lots of pediatric patients, but asthma is the cause of more than 775,000 ED visits for children each year.

Interestingly, most of the cases, 80%, are treated at community EDs, which is why a recent study published online by the journal Pediatrics looked at ways to improve care in that setting.

A study team led by researchers from Children’s National Health Systems in Washington implemented an evidence-based pediatric asthma guideline in a community ED as a quality improvement initiative. Included were patients whose clinical impression in the medical decision section of the electronic health record contained the words asthma, bronchospasm, or wheezing.

For the study, researchers reviewed charts of patients 12 months before guideline implementation (August 2012-July 2013) and 19 months after guideline implementation (August 2013-February 2015). While process measures included the proportion of children who had an asthma score recorded, the proportion who received steroids, and time to steroid administration, the outcome measure was the proportion of children who needed transfer for additional care.

With 289 patients included during the baseline period and 435 included after guideline implementation, results indicate that, overall, 64% of patients were assigned an asthma score after guideline implementation.

During the baseline period, 60% of patients received steroids during their ED visit, compared with 76% after guideline implementation – for an odds ratio of 2.2. After guideline implementation, the mean time to steroids decreased significantly, from 196 to 105 minutes.

In addition, according to the report, significantly fewer patients needed transfer after guideline implementation – 10%, compared with 14% during the baseline period.

“Our study shows that partnership between a pediatric tertiary care center and a community ED is feasible and can improve pediatric asthma care,” study authors conclude.