Successful implementation of evidence-based guidelines in a regional emergency department for children presenting with acute asthma

Abstract

Objective: To evaluate the adherence to asthma evidence-based guidelines before and after a quality improvement process.

Design: A controlled trial was conducted at two regional hospitals (intervention and control hospitals). We performed a retrospective pre-intervention audit, followed by a post-intervention audit 1 year after the implementation of evidence-based guidelines.

Setting: Emergency departments of two neighbouring hospitals serving regional and rural North West Tasmania.

Participants: All children (<18 years) with acute presentation of doctor-diagnosed asthma.

Interventions: Implementation of evidence-based guidelines using the National Asthma Council of Australia and the Global Initiative of Asthma guidelines, at the intervention hospital and care as usual at the control hospital.

Main outcome measure(s): The main outcome measures were the compliance to evidence-based guidelines, pre- and postintervention at the intervention hospital, compared to the control hospital. The specific outcomes measure included the clinical presentation, management, referral to asthma and allergy clinic, and hospitilisation.

Results: Significantly improved adherence to evidence-based guidelines were noted post-intervention at the intervention hospital, that is severity recorded (21.4%-45.7%, P < 0.001), triggers identified (13.5%-45.3%, P < 0.001), spirometry usage (3.8%-25.8%, P = 0.03) and written action plans (29.7%-58.3%, P < 0.001). There was however no effect on hospitilisation (23.3%-29.8%, P = 0.48). At the control hospital, however, no significant improved adherence to evidence-based guidelines were noted.

Conclusions: Evidence-based implementation led to improved adherence to evidence-based guidelines across an expanded list of domains in a regional setting.

Keywords: clinical; paediatric; respiratory; rural; standards.