PURPOSE OF THE STUDY.
To assess the utility of evidence-based standardized protocols (EBSPs) for children treated in emergency departments (EDs) for asthma compared with EDs with no standardized protocols (SPs) in Ontario, Canada.
Children with previously diagnosed asthma ages 2 to 17 years (N = 31 128) seen in 146 EDs in Ontario from April 2006 to March 2009.
The primary outcome measure for this retrospective population-based cohort study was hospital admission at the time of the index ED visit. Secondary outcomes included 7-day return visit to ED and 7-day outpatient follow-up visit.
Of 146 EDs, 70.5% did not use SPs for treating pediatric asthma. The cohort made a total of 46 510 ED visits. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% confidence interval (CI), 0.91–1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86–1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87–1.35], respectively).
In a multivariable analysis, the study authors found that there was no significant association between the use of SPs and outcomes. The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or outpatient follow-up visits.
EBSPs were defined as containing evidence-based format and content that was embedded into workflow; these included preprinted and clinical pathways (defined as structured multidisciplinary plans of care). Other SPs (nonevidence based) included clinical practice guidelines (systematically developed statements) and medical directives (standing orders that nurses or respiratory therapists can initiate). Limitations of this study include the inability to assess implementation of these protocols given its observational design. Moreover, none of the SPs were computerized, a feature shown to enhance clinical practice outcomes.
- Copyright © 2013 by the American Academy of Pediatrics