The Impact of Standardizing Assessment and Treatment of Acute Asthma Exacerbations on Emergency Department Efficiency

Abstract

Background: Emergency Department (ED) based Acute Asthma Exacerbation (AAE) clinical pathways effectively improve patient assessment, drug therapy, patient education, and discharge instructions. The effect of such protocols on hospital admission rates and ED length of stay are unclear.Objectives: Evaluate the impact of a standardized Asthma Treatment Protocol (ATP) on ED efficiency and return to the ED within 24 hours. Methods:This was a retrospective cohort analysis of 240 randomly selected patients presenting to the ED with AAE during the 3 months preceding and following the institution of an ATP. The primary outcome was the average Length of Stay (LOS) between Pre-ATP and ATP cohorts in patients discharged from the ED.Results: During the study 763 patients left the ED with a diagnosis of AAE. One hundred twenty cases were randomly selected from each cohort and reviewed to exclude secondary causes of dyspnea. There was no significant difference in AAE severity between the two groups. Despite this, the ATP cohort was more likely to be admitted to the hospital than the pre-ATP cohort (31.8% vs 11.7%, p<0.004). Though no difference was noted in the LOS in patients discharged home from the ED between the ATP and pre-ATP cohorts (223 minutes SD=113 versus 219 minutes SD=105, p=0.840), the significant increase in admission rate led to an overall increase in OS that was not statically significant (273 minutes (SD=134) versus 244 minutes (SD=141, p=0.21). More patients received disease specific asthma education in the ATP group than the pre-ATP group (79.1% vs 11.7%, p<0.0001). Conclusion:Institution of a standardized asthma treatment protocol appears to increase Emergency Department efficiency and allow for patient education and discharge planning in patient discharged from the ED, however it may increase the percentage of patients admitted to the hospital.