Association of Guideline‐concordant Acute Asthma Care in the Emergency Department With Shorter Hospital Length of Stay: A Multicenter Observational Study

Abstract

Objectives: The objectives were to determine whether guideline-concordant emergency department (ED) management of acute asthma is associated with a shorter hospital length of stay (LOS) among patients hospitalized for asthma.Methods: A multicenter chart review study of patients aged 2-54 years who were hospitalized for acute asthma at one of the 25 U.S. hospitals during 2012-2013. Based on level A recommendations from national asthma guidelines, we derived four process measures of ED treatment before hospitalization: inhaled b-agonists, inhaled anticholinergic agents, systemic corticosteroids, and lack of methylxanthines. The outcome measure was hospital LOS.Results: Among 854 ED patients subsequently hospitalized for acute asthma, 532 patients (62%) received care perfectly concordant with the four process measures in the ED. Overall, the median hospital LOS was 2 days (interquartile range = 1-3 days). In the multivariable negative binomial model, patients who received perfectly concordant ED asthma care had a significantly shorter hospital LOS (À17%, 95% confidence interval [CI] = À27% to À5%, p = 0.006), compared to other patients. In the mediation analysis, the direct effect of guideline-concordant ED asthma care on hospital LOS was similar to that of primary analysis (À16%, 95% CI = À27% to À5%, p = 0.005). By contrast, the indirect effect mediated by quality of inpatient asthma care was not significant, indicating that the effect of ED asthma care on hospital LOS was mediated through pathways other than quality of inpatient care. Conclusion:In this multicenter observational study, patients who received perfectly concordant asthma care in the ED had a shorter hospital LOS. Our findings encourage further adoption of guidelinerecommended emergency asthma care to improve patient outcomes.ACADEMIC EMERGENCY MEDICINE 2016;23:616-622

Does discharging asthma patients after one hour of treatment if clinically well affect emergency department length of stay

“…5 An observational study of 854 patients showed a significant reduction in the hospital LOS for patients managed via an asthma pathway compared to those who were not, independent of the quality of inpatient asthma care. 23 Our intervention not only resulted in a reduction in ED LOS but also led to a reduction in the admission rate of those children who were clinically well at the 1-h assessment. This may be partially explained by the results of a previous study which found that the duration of observation in ED is directly related to the likelihood of hospital admission.…”

“…The authors reported a reduction of 30 min in both ED LOS and time to inpatient bed request with the implementation of a standard asthma pathway with clear admission criteria . An observational study of 854 patients showed a significant reduction in the hospital LOS for patients managed via an asthma pathway compared to those who were not, independent of the quality of inpatient asthma care …”

Ohio Pediatric Asthma Repository: Opportunities to Revise Care Practices to Decrease Time to Physiologic Readiness for Discharge

“…When indicated by symptoms or physical findings (eg, fever, localized adventitious lung sounds, hypoxemia, or vomiting), initiating such interventions in the ED may shorten length of stay by 6 to 10 hours. 19,20 If this is the case, then there could be opportunities for improvement by incorporating evidencebased care algorithms in the ED, given the marked variations among the OPAR hospitals. Indeed, the use of validated assessment tools or development of more sensitive scores could expedite the identification of children with more severe illnesses who would benefit from an earlier initiation of treatments.…”

Smoking status and smoking cessation intervention among U.S. adults hospitalized for asthma exacerbation

“…10 The design, setting, and methods of data collection used in the study have been reported previously. [11][12][13][14] Briefly, we recruited hospitals by primarily inviting sites that had participated in the University HealthSystem Consortium Asthma Clinical Benchmarking Project that evaluated patients hospitalized for asthma exacerbation during 1999 to 2000. 5 A total of 25 urban teaching hospitals across 18 U.S. states completed the current 37th Multicenter Airway Research Collaboration study ( Supplemental Table E1).…”