Effect of an emergency department asthma program on acute asthma care

Ann Emerg Med. 1999 Sep;34(3):321-5. doi: 10.1016/s0196-0644(99)70125-3.


Study objective: To examine the effect of an emergency department program on acute asthma care.

Methods: We conducted a before-after study of an acute asthma quality improvement initiative in an urban teaching hospital with 65,000 annual ED visits. In mid-1994, a multidisciplinary group identified deficiencies in acute asthma care, developed and implemented a local version of the National Asthma Education Program's practice guidelines (including a standard asthma order sheet), and provided new peak flow (PF) meters. The "before" group comprised all adults with acute asthma seen during January 1994 (n=51); "after" groups comprised all adults with acute asthma seen during October 1994, February 1995, and June 1995 (n=145). Data were compared across months using a nonparametric test for trend.

Results: Although patient demographic characteristics and asthma severity were similar across months, ED process of care significantly changed. Initial PF measurements were obtained in 20% of patients before intervention, compared with 82%, 84%, and 83% during the postintervention months ( P for trend <.001). Follow-up PF readings were obtained in 22%, 70%, 78%, and 62% ( P <.001). Median delays to beta-agonist and steroid therapy decreased by approximately 16 minutes ( P <.001) and 34 minutes ( P =.04), respectively. Outcomes improved, with median ED length of stay decreasing by 58 minutes ( P =.01), and fewer inpatient admissions ( P =.05); there was no significant change in 4-week relapse to our hospital.

Conclusion: A guideline-based ED asthma program changed clinical practice and improved acute asthma care in a sustained fashion. The effect of this intervention on cost and other outcomes is uncertain.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adrenergic beta-Agonists / therapeutic use
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / diagnosis
  • Asthma / therapy*
  • Emergency Service, Hospital / standards*
  • Emergency Treatment / methods
  • Emergency Treatment / standards
  • Female
  • Follow-Up Studies
  • Hospitals, Teaching
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • New York City
  • Outcome and Process Assessment, Health Care
  • Patient Care Team / organization & administration
  • Peak Expiratory Flow Rate
  • Practice Guidelines as Topic
  • Program Evaluation
  • Statistics, Nonparametric
  • Steroids
  • Time Factors
  • Total Quality Management / organization & administration*


  • Adrenergic beta-Agonists
  • Anti-Inflammatory Agents
  • Steroids