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Managing asthma in accident and emergency departments: an assessment in non teaching hospitals
R Jayasuriya1, V Westley-Wise, T Dunn
1Department of Public Health & Nutrition, University of Wollongong, NSW, Australia.
Insights
Asthma patients frequently use Accident and Emergency (A&E) departments. Management and follow-up care in A&E were poorer in smaller hospitals, indicating a need for improved asthma protocols.
Area of Science:
- Pulmonary Medicine
- Emergency Medicine
- Healthcare Management
Background:
- Asthma patient management in Accident and Emergency (A&E) settings is primarily studied in specialized hospitals.
- Limited research exists on the quality of care provided in non-specialized, non-teaching hospitals.
Purpose of the Study:
- To evaluate the adequacy of asthma patient assessment, treatment, and follow-up in non-teaching hospital A&E departments.
- To compare asthma care quality across different A&E departments within a regional health system.
Main Methods:
- A case note audit of a 25% sample of asthma presentations to public hospitals in the Illawarra region over one year.
- Data extraction included demographics, assessment, management, and referral details from A&E and medical records.
- Statistical analysis using Chi-square and Fischer's Exact tests for inter-hospital comparisons.
Main Results:
- 359 asthma cases were audited; 88% were self-referred, and 5% were first-time presentations.
- Objective measures of airway obstruction were missing in 34% of admissions and 48% of non-admissions.
- Follow-up was not documented in 28% of cases, with significantly poorer assessment and management noted in smaller hospitals.
Conclusions:
- Accident and Emergency departments are heavily utilized as primary care facilities for asthma patients.
- There is a critical need for standardized protocols to enhance asthma assessment and treatment, particularly in smaller hospitals.
Background:
The management and follow-up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals.
Aims:
To study the adequacy of assessment, treatment and follow-up of patients presenting at A&E departments in non-teaching hospitals. To compare the assessment and management of asthma in A&E departments among hospitals in a health region.
Methods:
A twenty-five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals.
Results:
Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow-up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals.
Conclusion:
Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals.