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Compliance with the Canadian Association of Emergency Physicians' asthma clinical practice guidelines at a tertiary care emergency department

Published online by Cambridge University Press:  11 May 2015

Lyne Filiatrault ,
David Harriman ,
Riyad B. Abu-Laban ,
J. Mark FitzGerald ,
Anthony M. Chahal  and
R. Douglas McKnight
Lyne Filiatrault*
Affiliation:
Department of Emergency Medicine, University of British Columbia (UBC) Vancouver General Hospital, Vancouver Coastal Health (VCH)
David Harriman
Affiliation:
Faculty of Medicine, UBC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, University of British Columbia (UBC) Vancouver General Hospital, Vancouver Coastal Health (VCH) Centre for Clinical Epidemiology and Evaluation, VCH
J. Mark FitzGerald
Affiliation:
Vancouver General Hospital, Vancouver Coastal Health (VCH) Centre for Clinical Epidemiology and Evaluation, VCH Division of Respiratory Medicine, UBC, Vancouver, BC
Anthony M. Chahal
Affiliation:
Department of Emergency Medicine, University of British Columbia (UBC) Vancouver General Hospital, Vancouver Coastal Health (VCH)
R. Douglas McKnight
Affiliation:
Department of Emergency Medicine, University of British Columbia (UBC) Vancouver General Hospital, Vancouver Coastal Health (VCH)
*
Vancouver General Hospital Emergency Department, 855 West 12th Avenue, Vancouver, BC V5Z 1M9; [email protected].

Abstract

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Introduction:

Although evidence-based clinical practice guidelines (CPGs) exist, emergency department (ED) asthma management remains highly variable. Our objective was to compare asthma management at a tertiary care ED with that advised by the Canadian Association of Emergency Physicians' (CAEP) asthma CPG and current best practice.

Methods:

This medical record study enrolled patients between the ages of 19 and 60 years with a previous diagnosis of asthma who were seen for an acute asthma exacerbation at the Vancouver General Hospital ED in 2008. Standard methodology guidelines for medical record review were followed, including explicitly defined criteria and determination of interrater reliability. Primary outcomes were the proportion of cases with the following: objective assessment of severity using peak expiratory flow (PEF), use of systemic corticosteroids (SCSs) in the ED and at discharge, prescription for any inhaled corticosteroids (ICSs), and documentation of outpatient follow-up.

Results:

A total of 204 patient encounters were enrolled. Kappa values for interrater assessment ranged from 0.93 to 1.00. Compliance with primary outcomes was as follows: measurement of PEF, 90% (95% CI 85–94); use of SCSs in the ED, 64% (95% CI 57–71); prescription of SCSs at discharge, 59% (95% CI 51–67); prescription of any ICS at discharge, 51% (95% CI 41–61); and documentation of outpatient follow-up, 78% (95% CI 71–84).

Conclusions:

This study indicates an improvement in ED asthma care compared to previously published studies; however, discordance still exists between asthma management at a tertiary care ED and the CAEP asthma CPG and current best practice. Further research is warranted to understand the reasons for this finding.

Keywords

asthmacorticosteroidsemergency departmentguidelines
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 4 , July 2012 , pp. 228 - 236
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

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