Emergency department asthma: compliance with an evidence-based management algorithm

Ann Acad Med Singap. 2002 Jul;31(4):419-24.

Abstract

Background: Recent surveys in emergency medicine departments show inadequacies in many aspects of acute asthma management.

Objective: The objective of this study was to evaluate the adherence to management algorithm for acute asthma in the emergency department which focused on evidence-based treatment steps rather than documentation and patient classification.

Methods: A retrospective audit of consecutive adult patients with acute exacerbations of asthma in the emergency medicine department of a university hospital managed in the context of a clinical algorithm.

Results: We collated information from 344 episodes of acute asthma (94% of total) over a 4-month period. The first-line treatment was nebulised bronchodilators in 97%, combination of salbutamol and ipratropium bromide in 93% and the combination in recommended dosages in 87%. Systemic corticosteroid treatment was administered to 82% of patients. A further course of systemic corticosteroid was prescribed at discharge for 94% of patients. Overall, 93% of patients received some form of systemic corticosteroid treatment. The admission rate was 35.2%, and was significantly higher in women and the elderly. Of those who were admitted, 46.2% received > or = 3 nebulised treatments and 69% received intravenous hydrocortisone.

Conclusions: In the management of acute asthma, we found excellent compliance with specific treatment steps based upon clinical evidence. However, adherence to second-line treatment was less satisfactory. Nevertheless, whenever second-line treatment was complied with, reasonable outcomes were achieved. It may be more appropriate to emphasise evidence-based treatment rather than extensive documentation.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Asthma / therapy*
  • Emergency Service, Hospital / standards
  • Emergency Service, Hospital / statistics & numerical data*
  • Evidence-Based Medicine / standards
  • Evidence-Based Medicine / statistics & numerical data*
  • Female
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data*
  • Hospitals, University / standards
  • Hospitals, University / statistics & numerical data
  • Humans
  • Male
  • Medical Audit / standards
  • Medical Audit / statistics & numerical data
  • Middle Aged
  • Outcome Assessment, Health Care / standards
  • Outcome Assessment, Health Care / statistics & numerical data
  • Practice Guidelines as Topic / standards
  • Program Evaluation / standards
  • Program Evaluation / statistics & numerical data
  • Retrospective Studies
  • Severity of Illness Index