Survey of quality of care for asthmatic children seen in a pediatric emergency room

Objective: The purpose of this study was to determine whether the outpatient management of asthma of patients seen at a children's hospital emergency room followed the National Asthma Education Program (NAEP) 1991 guidelines. Design: A survey of specific patient- and physician-related issues for children with asthma seen at the Children's Hospital emergency room was performed. Setting: Children's Hospital of Buffalo Emergency Department. Patients: A cross-sectional survey of 137 children with asthma was obtained when they were admitted to the emergency department for an asthma exacerbation. Results: The mean age of study subjects was 6.9 +/- 5 years. Subjects denied having a written asthma management plan (75%), reported smoking exposure at home (43%), and denied trigger avoidance education (32%). Subjects also did not call their physician before coming to the emergency (44%), and were noncompliant with their medication (55%). Low rates of inhaled anti-inflammatory use were also found. No association was found between symptom recognition and early steroid intervention. These low rates of anti-inflammatory use, written asthma plan use, trigger avoidance, and early steroid intervention were not different for residential areas (urban vs. suburban), asthma severity, or insurance plan (p > 0.05). Conclusions: Use of a written asthma plan, trigger avoidance, communication between patient and physician, smoking cessation, and medication compliance are important aspects of outpatient asthma management as described in the NAEP guidelines. Our study identifies these areas as problems that impact on our pediatric patient population, particularly those who use the emergency for acute asthma care.