Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

Abstract

Objective: Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months. Results: A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child's asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child's future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child's asthma. Conclusion: Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations. RÉ SUMÉObjectif: Les communications entre le personnel des services d'urgence (SU) et les parents d'enfants asthmatiques peuvent jouer un rô le dans le traitement des crises d'asthme. L'é tude visait à vé rifier dans quelle mesure les parents concerné s appliquaient les recommandations donné es par le personnel des SU. Mé thode: Nous avons posé des questions aux parents sur les facteurs dé clencheurs des crises d'asthme, les soins reç us au SU (y compris l'enseignement et les recommandations faites au moment du congé ), et les straté gies de traitement de l'asthme appliqué es à domicile, peu de temps aprè s la consultation au SU, puis au bout de 6 mois. Ré sultats: Au total, 148 enfants asthmatiques ont é té sé lectionné s. Trente-deux pour cent des enfants n'é taient pas traité s par les corticosté roïdes en inhalation avant la consultation au SU, et 80% des parents ont indiqué une infection des voies respiratoires supé rieures (IVRS) comme principal facteur dé clencheur des crises d'asthme chez leur enfant. Aucun parent n'a reç u d'instructions particuliè res sur des straté gies visant à atté nuer l'incidence des IVRS sur l'asthme, ou n'a appliqué de straté gie en ce sens; 82% des parents ont dé claré ne pas avoir reç u de maté riel didactique é crit. La plupart des parents (66%) ont reç u des instructions verbales sur la maniè re de traiter les...

Parental Management of Discharge Instructions: A Systematic Review

“…54 The remaining articles were written in English; 73% of all studies were performed in the United States. Other studies were performed in Canada, 33,36,38,52,57,69,86 Israel, 82,83 Australia, 59 Rwanda, 39 Taiwan, 89 India, 79 Uganda, 87 Saudi Arabia, 53 and Switzerland. 65 In the following sections, studies will be summarized by domain of care.…”

Analysis of a Medication Safety Intervention in the Pediatric Emergency Department

“…[4][5][6][7] Despite studies suggesting that standardized verbal instructions, 8 assessing recall and comprehension of new information (teach-back), 9 and provision of dosing syringes are associated with a decreased risk of error 10 and improved outcomes, these strategies are not routinely used in ED discharge teaching. Current ED discharge instructions are brief, 11,12 lack key components, 12,13 and provide limited opportunities to confirm understanding, 14 with low rates of checking for comprehension 14 and dose demonstration. 12 Patients and families often leave the ED with insufficient understanding, 15 which frequently goes unrecognized.…”

Asthma exacerbations in the pediatric emergency area: Evaluation and prospects for improvement of pre-hospital care

“…3,8,[12][13][14] Several studies conducted in emergency departments have made it possible to specify the characteristics of the hospitalized pediatric population for asthma exacerbation. [15][16][17] The studies have highlighted the need to improve therapeutic education in asthmatic children but have not been able to study the population of consultants in non-emergency departments. Therefore, we did a multi-centric transversal study to identify the characteristics of children treated in pediatric emergency rooms for asthma exacerbation.…”