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Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department
Teeranai Sakulchit1, Wichapa Sathapornpunya1
1Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
Insights
Implementing pediatric asthma exacerbation guidelines in the emergency department (ED) showed partial physician adherence but improved patient care. Key improvements included increased outpatient follow-up and reduced hospital admissions for pediatric asthma patients.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Healthcare Quality Improvement
Background:
- Asthma exacerbations are a common reason for pediatric emergency department (ED) visits.
- Standardized guidelines can improve the quality of care for pediatric asthma exacerbations.
- Evaluating the impact of guideline implementation is crucial for optimizing ED protocols.
Purpose of the Study:
- To assess physician adherence to pediatric asthma exacerbation guidelines implemented in an ED.
- To evaluate the effect of guideline implementation on key ED quality indicators for pediatric asthma patients.
Main Methods:
- A single-center, retrospective, before-and-after study design.
- Inclusion of pediatric patients (<15 years) presenting with asthma exacerbation.
- Data collection pre-guideline (Jan 2020–Feb 2021) and post-guideline (Mar 2021–Dec 2022).
- Analysis of adherence using proportions and logistic regression for quality indicators.
Main Results:
- A total of 313 pediatric patients were analyzed (135 pre-guideline, 178 post-guideline).
- Overall physician adherence to guidelines was approximately 42.1%.
- Post-implementation, patients were significantly more likely to have scheduled outpatient follow-up (aOR 4.82) and less likely to be admitted (aOR 0.30).
Conclusions:
- Partial physician adherence to new guidelines in the ED was observed.
- Guideline implementation led to significant improvements in outpatient follow-up and reduced hospital admissions.
- Continuous monitoring, feedback, and education are recommended to sustain and enhance care quality for pediatric asthma exacerbations.
Purpose:
Pediatric asthma exacerbation guidelines were implemented in the emergency department (ED) of the Songklanagarind Hospital in March 2021. The primary outcome was physician adherence to the guideline. Secondary outcomes included comparisons of selected ED quality indicators.
Patients And Methods:
This single-center retrospective before-after study included children aged <15 years who presented with asthma exacerbation at the ED. Data were collected before guideline implementation (January 1, 2020, to February 28, 2021) and after implementation (March 1, 2021, to December 31, 2022). Guideline adherence was described as proportions. Between-period comparisons were analyzed using multivariable logistic regression to estimate odds ratios with 95% confidence intervals (CI).
Results:
A total of 313 pediatric patients met the inclusion criteria with 135 and 178 patients in the pre-and post-guideline groups, respectively. Overall adherence to the guidelines was approximately 42.1%. After implementation, patients were more likely to have scheduled outpatient follow-up on the next calendar business day (adjusted OR 4.82, 95% CI 2.33-10.38) and less likely to be admitted to the hospital (adjusted OR 0.30, 95% CI 0.11-0.76).
Conclusion:
Following the introduction of the guidelines in the ED, physician adherence was partial and was associated with significant improvements in some aspects of care quality. Ongoing review, feedback, education, and monitoring of time-sensitive care processes may help sustain and further improve the care of children with asthma exacerbations.
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