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'Evidence-based implementation' of paediatric asthma guidelines in a rural emergency department
Steven Doherty1, Peter Jones, Helen Stevens
1Emergency Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia. steven.doherty@hnehealth.nsw.gov.au
Insights
An evidence-based implementation strategy significantly improved pediatric asthma care compliance in a rural emergency department. Key improvements included documentation, spirometry, spacer use, and management plans, sustained over 12 months.
Area of Science:
- Pediatric Emergency Medicine
- Implementation Science
- Respiratory Care
Background:
- Acute asthma management in children requires adherence to evidence-based guidelines.
- Low compliance rates with asthma guidelines have been observed in emergency department settings.
- Effective implementation strategies are crucial for improving pediatric asthma care.
Purpose of the Study:
- To evaluate the impact of an evidence-based implementation (EBI) strategy on guideline compliance for acute asthma in children.
- To assess improvements in specific clinical indicators for pediatric asthma management in a rural emergency department.
Main Methods:
- A pre-intervention, post-intervention, and 12-month follow-up audit design was employed.
- Chart reviews were conducted to collect data on guideline compliance.
- An EBI strategy was implemented to promote adherence to established pediatric asthma management guidelines.
Main Results:
- Compliance with seven combined clinical indicators increased from 47% to 79% (P < 0.001).
- Significant improvements were noted in documentation of asthma severity (45% to 90%), spirometry use (32% to 66%), spacer use (5% to 53%), and management plans (16% to 69%).
- Positive clinical behavior changes were immediate and sustained at 12-month follow-up.
Conclusions:
- The EBI strategy effectively enhanced compliance with pediatric asthma guidelines in a rural emergency department.
- The observed improvements in clinical practice were significant and maintained over a 12-month period.
- This study highlights the success of EBI in improving the quality of acute asthma care for children.
Aim:
To determine if an evidence-based implementation (EBI) could lead to improved compliance with guidelines for acute asthma in children aged 1-15 years presenting to a large rural emergency department.
Methods:
Pre-intervention, post-intervention and 12-month follow-up audits were performed to determine the impact of an EBI strategy used to increase compliance with current asthma guidelines. The pre-intervention audit was conducted from 1 April to 30 June 2004, and follow-up data were collected from 1 September to 30 November 2004. The 12-month follow-up audit was conducted from 1 August to 31 October 2005. All audits were chart reviews. The intervention was an EBI strategy that was devised and then used to implement established guidelines for the emergency department management of paediatric asthma.
Results:
There were 51 presentations pre-intervention, 66 post-intervention and 68 at 12-month follow-up with no differences noted in the severity of asthma between the groups. At 12-month follow-up, there were significant increases in the documentation of asthma severity (45% to 90%, P < 0.001), use of spirometry (32% to 66%, P = 0.012), use of spacers (5% to 53%, P < 0.001) and use of written short-term asthma management plans (16% to 69%, P < 0.001). There was a reduction in the use of ipratropium bromide in mild asthma (31% to 3%, P < 0.001). There was no significant change in the use of systemic steroids (74% to 62%, P = 0.29) or antibiotic use in afebrile patients (15% to 6%, P = 0.175). For the seven clinical indicators (CIs) combined, compliance with the guideline increased from 47% to 79% (P < 0.001). Positive changes in clinical behaviour occurred immediately and compliance with all seven CIs was 83% immediately post intervention before falling, non-significantly, to 79% at 12-month follow-up (P = 0.142).
Conclusions:
The pre-intervention audit identified a low rate of compliance with current asthma guidelines across seven CIs of asthma care. The intervention significantly increased compliance with five of the CIs and for the seven CIs aggregated. Positive changes in clinical behaviour were immediate and the gains were sustained at 12 months.
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