Strategies reduce return hospital visits for asthma

By Will Boggs, MD

NEW YORK (Reuters Health) - Preprinted order sheets and access to a pediatrician are among strategies that can reduce the rate of return visits to the emergency department for children with asthma, a group of doctors from Canada has found.

"Standard order sets," Dr. Astrid Guttmann from the Institute for Clinical Evaluative Sciences, Ontario, told Reuters Health, "reduce bouncebacks to the emergency department." They are also an effective and inexpensive way to ensure that all children with asthma receive timely and appropriate care for asthma in emergency departments.

In the journal Pediatrics, Guttmann and colleagues describe current asthma management strategies for children used by emergency departments in the province of Ontario, and which strategies have an impact on 72-hour return visits by children.

Asthma management strategies were distributed across all hospital types, they note, but small community hospitals generally had lower adoption rates of all strategies than did large community hospitals and academic hospitals.

Two strategies -- the availability of a pediatrician for consultation and the use of a standard, preprinted order sheet -- were associated with significantly reduced return visits.

Employing both these strategies was associated with a 36 percent reduction in return-visit rates, the report indicates.

"This study cannot identify the specific components of these order sheets that account for their effectiveness," the investigators say, "but the timely use of evidence-based medications is likely to be an important component, given its consistent appearance in all of them."

"We think the evidence is compelling enough to move ahead with implementing asthma order sets for emergency departments, but we are considering studying order sets for other common conditions seen in emergency departments in a trial and collecting data about what processes are improved," Guttmann said.

SOURCE: Pediatrics December 2007.