2000 OPEN FORUM Abstracts
USE OF AN EDUCATION, MANAGMENT AND FOLLOW-UP PROTOCOL FOR EMERGENCY ROOM (ER) ASTHMATIC PATIENTS
Chris Garvey, RN, MPA, GeneAnn La Moria, RRT, BA, Stephen Park, MD, David Goldschmid, MD, Jeff Clingan, RN, MS, Seton Medical Center, Daly City, CA
BACKGROUND: Emergency room and inpatient care accounts for a significant portion of total asthma care costs. Acute care management of asthma may be largely due to uncontrolled disease. Asthma-related ER visits and hospitalizations may be reduced if disease control is improved. The purpose's of this project are to: (1) provide education and management to ER patient's with moderate to severe asthma based on NIH 'Guidelines for the Diagnosis and Management of Asthma-1997', (2) provide short term follow-up to assess compliance and provide education, and (3) assess the impact of the intervention and follow-up on ER and hospital revisit rate. METHOD: 485 patients with moderate persistent to severe persistent asthma (based on self-report of daily or more frequent asthma symptoms) were seen for ER care at our private community hospital between 2/98 and 1/00. All patients received a standardized intervention provided by RCPs based on the 1997 NIH asthma guidelines. The intervention includes education about disease process and control methods, trigger identification and control, use of MDI and holding chamber with return demonstration, Peak Flow Meter use with return demonstration, importance of reporting of asthma symptoms to PCP, follow-up with PCP and regular use of 'controller' medication, and referral to asthma education class. Phone follow-up within 4 days of ER asthma visit includes assessment of presence of asthma-related symptoms, medication and peak flow adherence, patient follow-up with PCP, and education of disease self-management techniques. Of all patients in the sample, 56% (n=271) received telephone follow-up within 4 days of ER visit. Forty-four percent (n=214) did not answer 3 phone calls. Three months after the initial ER asthma visit and intervention, respiratory ER and / or respiratory hospitalization revisit rate was assessed by medical record review of all patients.
Results: For the total sample, ER revisit rate for respiratory illness within 3 months of ER asthma intervention decreased 43% during the 2 years of the study. Hospital admission for respiratory illness within 3 months of the ER asthma intervention decreased 10% during the 2 years of the study. Patient self-report of medication adherence averaged 90%. CONCLUSION: Patients demonstrate decreased respiratory ER visits and respiratory hospitalizations after a standardized asthma ER intervention.