Compliance With Asthma Guidelines and Association With Outcomes in the Emergency Department of a Tertiary Care Teaching Hospital

Background: Despite the existence of guidelines for treating acute asthma patients in the emergency department (ED), compliance is often poor. We aimed to examine the compliance to treatment guidelines for asthma at our tertiary care teaching hospital's ED and association with re-attendance rates. Methods: We performed a retrospective analysis of electronic patient records of patients above 16 years old who presented to our ED with a primary diagnosis of asthma over a 6 month period in 2012. Patient demographics such as age, gender, history of previous intubations and hospitalisations were reviewed, as were the treatment administered during the ED visit and on discharge. Concordance of treatment was compared with the National Asthma Education and Prevention Program's Expert Panel Report 3 (NAEPP EPR3) guidelines. Re-attendance rates to our ED within one year were then analysed. Results: A total of 552 patients were included in the study. We found that 151 (27.4%) of patients reattended within the year, 35 (6.3%) returned more than twice. Low compliance to the EPR3 guidelines (p = 0.005), age of between 41 and 60 (p = 0.049), previous hospitalisations for asthma (p < 0.001) and non-use of recommended systemic corticosteroids (p = 0.020) in the ED predicted a higher re-attendance rate. Follow up care and medications on discharge were not significant factors. Conclusion: Low compliance to recommended treatment by established guidelines is associated with higher re-attendance, as are middle age and previous hospitalisations. Besides managing pressures of time and resource limitations in the ED, an increased awareness of guidelines amongst doctors will improve asthma care.