Asthma accounts for 11.9 million Emergency Department (ED) visits and 454,000 inpatient stays per year in the United States. Asthma takes it toll not only in human lives but also in cost to the patient and the healthcare system. Asthma entails an annual economic cost to our nation of $14.0 billion in direct and indirect health care costs. Inpatient hospital services represent the single largest direct expenditure. We initiated an Emergency Department protocol to improve our delivery of care to the individual with asthma.
In January 2001 we initiated a protocol for the treatment of asthma in the ED at a 237-bed facility serving the urban core of Kansas City, Missouri based on the National Institutes of Health, Guidelines for the Diagnosis and Management of Asthma. Placement of the patient into the protocol is assessed at triage. The patient with asthma or symptoms of asthma receives 3 aerosol treatments with peak flow assessment before and after treatment, systemic steroids, education about their disease including: peak flow monitoring, medications and proper use as well as an asthma action plan. The patient is further provided with a controller medication and instructed to use on a daily basis and to follow up with their primary care provider.
In 2000 (pre-protocol), 24.8% of patients presenting to the ED with a diagnosis of asthma (ICD-9CM 493.xx) were admitted to the inpatient setting. Subsequent years after protocol implementation for admission to inpatient are as follows: 2001, 21.8%, 2002, 18.8%, 2003, 19.8%. The projected cost savings in healthcare dollars of this decreased admission rate is $569,609.
The use of guideline directed care in the ED can have a significant impact on the admission rate for asthma. Further evaluation is planned regarding the impact of this protocol on the indirect costs, decreased ED costs and re-exacerbation rates.
Implementation of a protocol for the management of asthma in the ED can be effective and have a significant impact on the cost of asthma care.
R.A. Mangold, None.