2004 OPEN FORUM Abstracts
RESPIRATORY THERAPISTS (RT’S) INTEGRAL ROLE OF ASTHMA MANAGEMENT IN THE EMERGENCY DEPARTMENT (ED)
Rhonda Vosmus, RRT, NPS, AE-C,
Maine Medical Center, Portland, ME
BACKGROUND: Respiratory therapists (RT’s) are one of the first healthcare providers to come in contact with an asthma patient in the Emergency Department (ED) at Maine Medical Center (MMC). The RT assesses treats and creates an action plan for asthma patients. Prior to the AH! Asthma Health Program educational intervention, there was no consistent patient education, patient educational materials were scarce and there was no tracking mechanism for follow up of asthma patients utilizing the ED.
METHOD: We provided asthma education and a skill testing for all seventy-four RT’s at MMC. Patients who received nebulized medication in the ED were asked two questions. “Have you been diagnosed with asthma in the past?” and “Are you on inhaled steroids?” If the patient or family member answered yes to either question the RT shared five basic asthma messages. (1) Asthma is a chronic inflammatory disease (2) There are two types of medicines to treat asthma: controller and quick relief (3) Triggers can make your asthma worse (4) Monitor your symptoms, and (5) Asthma plans and regular visits to your healthcare provider can help control your asthma. The RT and ED physician developed and reviewed a written emergency asthma plan with the patient/family and gave them a brochure, which listed additional educational resources. The asthma educator reviewed a copy of the emergency action plan and provided telephone follow up.
RESULTS: During the eighteen-month period from September 2002 to March 2004, 322 emergency asthma plans were written. This was a 100% increase in written plans prior to the educational intervention. In addition, (7%) patients were identified as not having a primary care provider, (12%) patients were eligible for uncompensated care and were enrolled in appropriate assistance programs (i.e., out patient clinics, Medicaid, pharmaceutical drug programs), (39%) patients/families were provided with education by telephone, and (12%) patients scheduled a follow up appointment with an asthma educator. We also sent a mailing to (30%) patients who could not be reached by telephone, but were still unsuccessful in reaching them.
EXPERIENCE: We found patients and families were receptive to follow up telephone conversations about their asthma. Limitations included phone numbers that were not always current in electronic medical records and workloads that often restricted the availability of education in a level one-trauma center.
CONCLUSION: Written plans are helpful tools to track ED asthma utilization. Reinforcement of basic asthma messages by the health care team is an essential part of our partnership with the patient and family. Patients with financial constraints were connected to assistance programs and patients without a provider were connected with our clinics, thus reducing the impetus to use the ED as their primary place of care. Positive outcomes resulting from this process improvement project are encouraging, more specific follow up data after intervention maybe helpful in showing reduced ED utilization for asthma management. The RT’s at MMC have been given a more active role in collaborating with asthma management and have self reported enhanced job satisfaction.