PURPOSE: Although asthma attacks are often preventable many patients still seek care in the emergency department (ED) setting. Appropriate follow up care, management, and education are crucial to reduce ED visits. Our project sought to break the cycle of recurrent emergency care by assisting patients into preventative care clinics.
METHODS: The University of Missouri-Kansas City School of Medicine (UMKC) is affiliated with Truman Medical Center-Hospital Hill, (TMC-HH) a 267 bed acute care facility located in the urban core of Kansas City, Missouri. TMC-HH’s annual ED volume is 57,000. TMC-HH typically sees 50% of all ED cases for adult asthma in Kansas City, Missouri. In the years 2001-2003, our ED saw an average of 104 visits per month for asthma, while average cases in the Pulmonary/Asthma Clinic were 60 visits per month.Information regarding patients seen in the ED for asthma was obtained on a daily basis by the Asthma Program Coordinator, who reviewed the patient’s discharge instructions. Patients were then contacted by telephone regarding making a follow up appointment. If the patient had a primary care provider, they were reminded to follow up with that provider. If the patient had been seen in the Asthma Clinic before, noted to have high ED utilization or did not have a primary care provider they were asked to come to the Asthma Clinic for follow up care.
RESULTS: Since instituting the telephone follow up for ED asthma visits, ED visits have decreased to an average of 63 visits per month while visits for asthma in the Pulmonary Clinic have increased to an average of 87 per month for the year 2005.
CONCLUSION: These numbers demonstrate a significant shift from emergent care to preventative care. Once seen in the Asthma Clinic they could be evaluated, their diagnosis of asthma validated, and provided with resources to match the patient’s needs.
CLINICAL IMPLICATIONS: Telephone contact regarding follow-up care after an ED visit for asthma can have a significant impact on ED utilization.
DISCLOSURE: Rita Mangold, None.