Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: implementation of a dynamic and integrated electronic decision support system

Emerg Med Australas. 2009 Feb;21(1):31-7. doi: 10.1111/j.1742-6723.2008.01149.x.


Objective: The authors previously developed a dynamic and integrated electronic decision support system called ACAFE (Asthma Clinical Assessment Form and Electronic decision support). The objective of this present study was to evaluate the effectiveness of this system on asthma management and documentation in an ED.

Method: Observational study using a pre- and post-intervention design, comparing patients managed using ACAFE after its implementation with historical controls. A systematic data abstraction process was used to compare patient records.

Results: A total of 50 patients were enrolled in the study group. These were compared with 50 historical controls. Use of ACAFE was associated with significantly higher rates of documentation of asthma severity (98% vs 18%, P < 0.01), as well as other clinically important variables, such as asthma precipitants, intensive care admission history and smoking history. ACAFE was also associated with significantly higher rate of asthma discharge plan documentation (76% vs 16%, P < 0.01), and this remained significant after adjustment for triage category and seniority of treating doctor in a regression model.

Conclusion: The use of this decision support system in patients presenting to emergency with asthma was associated with improvements in clinical documentation and discharge management plans. Electronic decision support systems developed collaboratively with clinicians should play an important part of system-wide efforts to improve guideline adherence and compliance in ED.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Asthma / therapy*
  • Clinical Protocols*
  • Decision Support Systems, Clinical / instrumentation*
  • Documentation / standards*
  • Emergency Service, Hospital / standards*
  • Female
  • Guideline Adherence* / statistics & numerical data
  • Guidelines as Topic
  • Humans
  • Logistic Models
  • Male
  • New South Wales
  • Odds Ratio
  • Outcome and Process Assessment, Health Care
  • Patient Discharge / standards*
  • Young Adult