Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

Download Full-text

The effect of a zero-diversion policy on emergency department performance measures

Journal of Hospital Administration ◽

10.5430/jha.v2n4p144 ◽

2013 ◽

Vol 2 (4) ◽

pp. 144

Author(s):

Eman Spaulding ◽

Laurie Byrne ◽

Eric Armbrecht ◽

Collin Jackson ◽

Preeti Dalawari

Keyword(s):

Emergency Department ◽

Performance Measures ◽

Care Center ◽

Tertiary Care ◽

Admission Rate ◽

Medical Advice ◽

Hospital Admission Rate ◽

Left Without Being Seen ◽

Before And After ◽

Discharged Patients

This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy. Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate. Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy.

Download Full-text

Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-020-01837-9 ◽

2021 ◽

Author(s):

Laura C. Blomaard ◽

Bas de Groot ◽

Jacinta A. Lucke ◽

Jelle de Gelder ◽

Anja M. Booijen ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Older Patients ◽

Screening Program ◽

Admission Rate ◽

Older Patient ◽

Hospital Admission Rate ◽

High Risk Patients ◽

Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Download Full-text

Acute asthma severity identification of expert system flow in emergency department

10.1063/1.5012215 ◽

2017 ◽

Author(s):

Nurul Atikah Mohd Sharif ◽

Norazura Ahmad ◽

Nazihah Ahmad ◽

Wan Laailatul Hanim Mat Desa

Keyword(s):

Emergency Department ◽

Expert System ◽

Acute Asthma ◽

Asthma Severity ◽

System Flow

Download Full-text

Individual care plans can reduce hospital admission rate for patients who frequently attend the emergency department

Emergency Medicine Journal ◽

10.1136/emj.2009.085704 ◽

2010 ◽

Vol 28 (8) ◽

pp. 654-657 ◽

Cited By ~ 8

Author(s):

A. Newton ◽

S. J. Sarker ◽

A. Parfitt ◽

K. Henderson ◽

P. Jaye ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Admission Rate ◽

Hospital Admission Rate ◽

Care Plans ◽

Individual Care

Download Full-text

Impact of inaccuracy of peak flowmeters with Wright scale on asthma severity assessment in children

Medicinski pregled ◽

10.2298/mpns0808354s ◽

2008 ◽

Vol 61 (7-8) ◽

pp. 354-358 ◽

Cited By ~ 1

Author(s):

Dragana Stamatovic ◽

Nada Bokan-Erdeljan ◽

Milan Gajic ◽

Zorica Vujnovic-Zivkovic

Keyword(s):

European Union ◽

Asthma Management ◽

Asthma Severity ◽

Study Group ◽

Severity Assessment ◽

Objective Method ◽

Predictive Equation ◽

Asthmatic Children ◽

Before And After ◽

Daily Variability

Introduction Measurement of daily variability of peak expiratory flow (PEF) is widely accepted as an objective method to assess asthma severity. Recent investigations have proved nonlinearity of original Wright scale of peak flowmeter. All country members of European Union have been obliged to implement a new scale according to standard EN 13826 since 2005. This study examined whether the correction of PEF values for the inaccuracy of the scale would affect asthma management based on their daily variability. Material and methods We analyzed PEF values (2352) in 34 children, aged 5-16, during 3-5 weeks of monitoring in order to establish the diagnosis of asthma by using peak flowmeters with Write scale. The correction of measured values for inaccuracy was managed with original Dr M. Miller's predictive equation. The daily variability of PEF (amplitude percent mean) up to 20% was considered as 'normal', 20-29.9% as 'raised', and 30% and above as 'high'. The assessment of daily variability was performed before and after correction. Results There was no significant change in the number of days with airway liability as regarding the assessed whole study group (p=0.475). However, 22 (64.7%) of children had at least one false clinical message about daily variability during the monitoring. It was overestimated in 12 (7%) days in younger (6.6?0.8 years) or of shorter stature (122.6?3.6cm) and underestimated in 13 (4%) days in older (11.1?2.7) or taller ones (150.9?12.5 cm) (p<0.001). Conclusion Usage of peak flowmeters with Wright scale may lead to an error in asthma severity assessment based on daily variability of PEF. It may cause overtreatment or undertreatment of asthmatic children.

Download Full-text

Comparison of Traumatic Brain Injury Patients by Age Group in Emergency Department

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19002310 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s110-s110

Author(s):

Kwang-Real Huh ◽

Jung-youn Kim ◽

Young-Hoon Yoon ◽

Sung-Woo Moon ◽

Eu-Sun Lee ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Admission Rate ◽

University Hospital ◽

Health Concern ◽

Utilization Rate ◽

Trauma Patients ◽

Age Group ◽

Brain Ct

Introduction:Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.Aim:The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.Methods:Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.Results:A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.Discussion:Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.

Download Full-text