Emergency departments (EDs) represent an important source of asthma
care, yet there are few studies detailing how ED asthma practices vary
and to what extent EDs meet expectations of national asthma guidelines.
The purpose of this study is to characterize ED care for persons with
asthma in a single large community.
1996 and 1997, a cross-sectional, self-administered survey to
characterize asthma care practices was conducted among medical
directors of the 89 EDs serving the Chicago metropolitan area (six
counties). The survey topic areas included asthma-specific demographics
and selected utilization statistics; assessment practices; treatment
practices; discharge and follow-up activities; and familiarity with,
attitudes toward, and utilization of guidelines/protocols.
Results: Sixty-four EDs completed surveys, for a response
rate of 71.9%. Ninety-four percent of the respondents were ED medical
directors. As part of assessment, peak flow measurements, while common,
were used less frequently than pulse oximetry. The average
(± SE) estimated length of stay for asthma care was
3.0 ± 0.1 h, and average disposition time (ie, the
decision to admit) was 2.5 ± 0.2 h. Systemic steroids (either IV or
po) were estimated to be given to 73.2 ± 3.9% of patients
during their ED visits. Systemic steroids were prescribed for
55.9 ± 3.5% of patients at time of discharge. Only 57.0 ± 5.4%
of patients were estimated to have received any type of written asthma
educational materials. Approximately 25% of patients were reported to
have been given a detailed follow-up appointment at the time of
Conclusion: The results reveal that the
medical directors reported many of the Chicago-area EDs as providing
asthma care that is consistent with key aspects of national guidelines.
However, in certain critical areas of care, the EDs demonstrate a high
degree of variation, often with the community falling short of
guideline recommendations. By identifying these variations in asthma
care, it is now possible to target specific goals for community-wide
asthma quality improvement among the EDs in the Chicago metropolitan