Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1402-e1410 (doi:10.1542/peds.2007-0168)
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ARTICLE

Effectiveness of Emergency Department Asthma Management Strategies on Return Visits in Children: A Population-Based Study

Astrid Guttmann, MDCM, MSca,b,c,d,e, Brandon Zagorski, MSca, Peter C. Austin, PhDa,d,f, Michael Schull, MD, MSca,d,g, Asma Razzaq, MPHa, Teresa To, PhDa,c,d,e,f and Geoff Anderson, MD, PhDa,d

a Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
b Divisions of Pediatric and Emergency Medicine
e Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
c Department of Pediatrics, Faculty of Medicine
Departments of d Health Policy, Management, and Evaluation
f Public Health Sciences
g Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

BACKGROUND. Emergency departments play an important role in the care of children with asthma. Emergency department return-visit rates provide a measure of the quality of acute asthma care.

OBJECTIVE. Our goal was to describe the characteristics of children treated in emergency departments for asthma, the resources and asthma management strategies used by emergency departments, and their effect on return visits within 72 hours.

DESIGN, SETTING, AND PATIENTS. We used a population-based cohort study that incorporated both comprehensive administrative heath and survey data from all 152 emergency departments in Ontario, Canada. We studied all 2- to 17-year-old children who had a visit to an emergency department for asthma from April 2003 to March 2005.

RESULTS. A total of 32996 children (>9% of children with asthma in Ontario) had at least 1 visit to an emergency department for the care of asthma, and most of these visits (68.5%) were triaged as high acuity. The vast majority (148 of 152 [97%]) of emergency departments reported using at least 1 asthma management strategy, and 74% used 3 or more. The overall return-visit rate was 5.6%. Logistic regression models that accounted for the clustering of patients in emergency departments and controlled for patient and emergency department characteristics indicated that preprinted order sheets and access to a pediatrician for consultation were strategies significantly associated with a reduction in return visits. The 11 (17%) emergency departments that used both of these strategies had return visit rates of 4.4% compared with 6.9% in the 95 (63%) that used neither strategy.

CONCLUSIONS. Emergency departments use a range of strategies to manage asthma in children. Preprinted order sheets and access to pediatricians are associated with important reductions in return-visit rates, and more emergency departments should consider using these strategies.

Key Words: asthma • return visits • emergency department • standardized order sheets • guidelines

Abbreviations: ED—emergency department • OR—odds ratio • CI—confidence interval

Accepted May 16, 2007.