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Asthma Care Practices in Chicago-Area Emergency Departments^*

Michael F. McDermott, MD; Evalyn N. Grant, MD; Karen Turner-Roan, MPH; Tao Li, PhD; Kevin B. Weiss, MD and for the Chicago Asthma Surveillance Initiative Project Team

^* From the Departments of Emergency Medicine and Internal Medicine (Dr. McDermott), Cook County Hospital, Chicago, IL; Center for Health Services Research (Drs. Li and Weiss, and Ms. Turner-Roan), Rush Primary Care Institute, Department of Immunology and Microbiology (Dr. Grant), Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL. See Appendix for other members of the CASI Project Team.

Correspondence to: Kevin B. Weiss, MD, Director, Center for Health Services Research, Rush Primary Care Institute, Rush-Presbyterian-St. Luke's Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612

Introduction: Emergency departments (EDs) represent an important source of asthma care, yet there are few studies detailing how ED asthma practices vary and to what extent EDs meet expectations of national asthma guidelines. The purpose of this study is to characterize ED care for persons with asthma in a single large community.

Methods: During 1996 and 1997, a cross-sectional, self-administered survey to characterize asthma care practices was conducted among medical directors of the 89 EDs serving the Chicago metropolitan area (six counties). The survey topic areas included asthma-specific demographics and selected utilization statistics; assessment practices; treatment practices; discharge and follow-up activities; and familiarity with, attitudes toward, and utilization of guidelines/protocols.

Results: Sixty-four EDs completed surveys, for a response rate of 71.9%. Ninety-four percent of the respondents were ED medical directors. As part of assessment, peak flow measurements, while common, were used less frequently than pulse oximetry. The average (± SE) estimated length of stay for asthma care was 3.0 ± 0.1 h, and average disposition time (ie, the decision to admit) was 2.5 ± 0.2 h. Systemic steroids (either IV or po) were estimated to be given to 73.2 ± 3.9% of patients during their ED visits. Systemic steroids were prescribed for 55.9 ± 3.5% of patients at time of discharge. Only 57.0 ± 5.4% of patients were estimated to have received any type of written asthma educational materials. Approximately 25% of patients were reported to have been given a detailed follow-up appointment at the time of discharge.

Conclusion: The results reveal that the medical directors reported many of the Chicago-area EDs as providing asthma care that is consistent with key aspects of national guidelines. However, in certain critical areas of care, the EDs demonstrate a high degree of variation, often with the community falling short of guideline recommendations. By identifying these variations in asthma care, it is now possible to target specific goals for community-wide asthma quality improvement among the EDs in the Chicago metropolitan area.

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