BACKGROUND: Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of <120 min.
METHODS: A flow chart diagram, a fishbone diagram, data collection, intervention implementation, and data monitoring and analysis were used in this study. Data were collected on a pre-test of change cohort of 227 subjects with asthma from January 2013 to March 2014. A test of change adding a Q2H respiratory therapist assessment and as needed bronchodilator treatment order while the subject was in the emergency department was implemented during May of 2014. These data were compared with a post-test of change cohort of 278 subjects with asthma from May 2014 to July 2015. Data collection for both cohorts included the time from the last assessment/bronchodilator treatment in the emergency department to emergency department discharge, the time from emergency department discharge to assessment/treatment in the medical ward, and the sum of these 2 time periods. Mean times (minutes) were noted, and comparisons were made using 2-tailed independent t tests with significance set at P < .05. Mean monthly times were also compared in process control charts.
RESULTS: There was a 124% increase noted in the percentage of subjects who received bronchodilator treatment within 120 min, a 53% increase within 180 min, and a 19% increase within 240 min. The interval time between treatments decreased 21%.
CONCLUSIONS: Through quality improvement methodology, the group was able to significantly decrease the time between the last assessment/bronchodilator treatment in the emergency department and the first assessment/treatment in the medical ward for subjects with asthma. Moreover, improvement was seen in all studied parameters despite similar volumes in emergency department visits.
- quality improvement
- asthma exacerbation
- respiratory assessment
- pediatric asthma
- emergency department
- Correspondence: Jennifer Cockerham, Slot 303, 1 Children's Way, Little Rock, AR 72202. E-mail: .
Dr Berlinski has disclosed relationships with Vertex, AbbVie, Aptalis Pharma, Genentech, Janssen Research and Development, Gilead, Teva, Philips, Novartis, the National Institutes of Health, and the Therapeutic Development Network. The other authors have disclosed no conflicts of interest.
Mr Willis presented a version of this paper at AARC Congress 2014, held December 9-12, 2014, in Las Vegas, Nevada. Ms Cockerham presented a version of this paper as an Editors' Choice abstract at AARC Congress 2015, held November 6-10, 2015, in Tampa, Florida.
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