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Compliance with guidelines for emergency management of asthma in adults: experience at a tertiary care teaching hospital

Published online by Cambridge University Press:  21 May 2015

Valerie F. Krym ,
Brent Crawford  and
Russell D. MacDonald
Valerie F. Krym
Affiliation:
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Man., and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont
Brent Crawford
Affiliation:
Department of Family Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Man
Russell D. MacDonald*
Affiliation:
Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Ontario Air Ambulance Base Hospital Program, Division of Prehospital Care, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ont
*
Ontario Air Ambulance, 1120 Finch Ave. W, Ste. 405, Toronto ON M3J 3H7; 416 667-2200, fax 416 667-2229, rmacdonald@basehospital.on.ca

Abstract

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Objectives:

Despite evidence-based clinical practice guidelines for the emergency management of asthma, substantial treatment variation exists. Our objective was to assess compliance with the Canadian Association of Emergency Physicians (CAEP) / Canadian Thoracic Society (CTS) Asthma Advisory Committee’s “Guidelines for the emergency management of asthma in adults” in the emergency department (ED) of a university-affiliated tertiary care teaching hospital.

Methods:

This retrospective study was conducted in a Canadian inner city adult ED. Investigators reviewed all ED records for the period from Jan. 1, 2001, to Dec. 31, 2001, and identified adult patients (i.e., >18 years of age) with a primary ED diagnosis of asthma. Hospital records were then reviewed to document compliance with the CAEP/CTS asthma guidelines. Descriptive statistics, including means, standard deviations and frequencies were used to summarize information.

Results:

Overall compliance with the guidelines was 69.6%, (95% confidence interval, 64.7%–74.5%), but compliance ranged from 41.4% for severe asthma, 67.1% for moderate asthma, and 88.6% for mild asthma. Interobserver reliability for compliance assessment was excellent.

Conclusions:

Despite publication and dissemination of evidence-based guidelines for the management of acute asthma in adults, guideline compliance at a university-affiliated, inner city, tertiary care teaching hospital ED is suboptimal.

Keywords

asthmapractice guidelinecritical pathwaysemergency medicine
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 321 - 326
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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