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Childhood asthma in the emergency department: an audit
1Emergency Department, Huddersfield Royal Infirmary, Acre Street, Lindley, Huddersfield HD3 3EA, UK.
Insights
This audit of pediatric asthma care in the Emergency Department found gaps in vital sign monitoring and follow-up management. Improvements are needed to ensure effective treatment for children with acute asthma.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Healthcare Quality Improvement
Background:
- Rising prevalence of childhood asthma necessitates effective emergency care.
- Preventable asthma-related deaths in children highlight critical care gaps.
- Emergency Departments (EDs) play a crucial role in managing acute pediatric asthma.
Purpose of the Study:
- To evaluate the effectiveness of ED management for pediatric acute asthma.
- To identify specific areas for improvement in current asthma care protocols.
- To assess adherence to best practices in pediatric asthma treatment within an ED setting.
Main Methods:
- Retrospective audit of 50 consecutive pediatric acute asthma presentations.
- Review of patient records for initial and post-management vital signs.
- Assessment of timely initial management, medication administration, and further care planning.
Main Results:
- Deficiencies noted in systolic blood pressure (14%), conscious level (30%), and peak flow (46%) measurements.
- High rates of correct beta-2 agonist (96%) and steroid (82%) administration.
- Inconsistent recording of post-management vital signs (approx. 50%) and appropriate discharge medication (36%).
Conclusions:
- Key aspects of pediatric asthma management are being overlooked in the ED.
- An improved integrated care pathway is proposed to address identified deficiencies.
- Enhancing ED protocols can improve outcomes for children with acute asthma.
Introduction:
The prevalence of asthma has been rising, particularly in younger age groups. In the 12-month period from February 2012 there were 28 deaths due to asthma in children under 18 in the United Kingdom, the majority of which were preventable. The purpose of this audit was to determine how effective our Emergency Department is at managing children presenting with acute asthma.
Method:
We undertook a retrospective audit of 50 consecutive presentations to Huddersfield Royal Infirmary Emergency Department between 1 August 2013 and 31 March 2014 that met the inclusion criteria. Whether each patient had initial vital signs, timely initial management, vital signs after initial management, and appropriate further management were audited.
Results:
The majority of patients were male; mean age was 8.5 years. There were deficiencies in measurements for systolic blood pressure (14%), conscious level (30%), and peak flow (46%). Most patients received the correct dose of β2 agonist (96%) and oral or IV steroid (82%). Approximately 50% had further vital signs recorded. Thirty-six per cent were discharged with the correct dose of prednisolone.
Conclusion:
Certain aspects of the management of childhood asthma are being overlooked. We have suggested an improved integrated care pathway that we feel will improve the deficiencies highlighted.
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