McDermott M F, Grant E N, Turner-Roan K, Li T, Weiss K B
Department of Emergency Medicine, Cook County Hospital, Chicago, IL, USA.
Chest. 1999 Oct;116(4 Suppl 1):167S-173S. doi: 10.1378/chest.116.suppl_2.167s.
Emergency departments (EDs) represent an important source of asthma care, yet there are few studies detailing how ED asthma practices vary and to what extent EDs meet expectations of national asthma guidelines. The purpose of this study is to characterize ED care for persons with asthma in a single large community.
During 1996 and 1997, a cross-sectional, self-administered survey to characterize asthma care practices was conducted among medical directors of the 89 EDs serving the Chicago metropolitan area (six counties). The survey topic areas included asthma-specific demographics and selected utilization statistics; assessment practices; treatment practices; discharge and follow-up activities; and familiarity with, attitudes toward, and utilization of guidelines/ protocols.
Sixty-four EDs completed surveys, for a response rate of 71.9%. Ninety-four percent of the respondents were ED medical directors. As part of assessment, peak flow measurements, while common, were used less frequently than pulse oximetry. The average (+/- SE) estimated length of stay for asthma care was 3.0 +/- 0.1 h, and average disposition time (ie, the decision to admit) was 2.5 +/- 0.2 h. Systemic steroids (either i.v. or p.o.) were estimated to be given to 73.2 +/- 3.9% of patients during their ED visits. Systemic steroids were prescribed for 55.9 +/- 3.5% of patients at time of discharge. Only 57.0 +/- 5.4% of patients were estimated to have received any type of written asthma educational materials. Approximately 25% of patients were reported to have been given a detailed follow-up appointment at the time of discharge.
The results reveal that the medical directors reported many of the Chicago-area EDs as providing asthma care that is consistent with key aspects of national guidelines. However, in certain critical areas of care, the EDs demonstrate a high degree of variation, often with the community falling short of guideline recommendations. By identifying these variations in asthma care, it is now possible to target specific goals for community-wide asthma quality improvement among the EDs in the Chicago metropolitan area.
急诊科是哮喘治疗的重要场所，但很少有研究详细说明急诊科的哮喘治疗方法有何不同，以及急诊科在多大程度上符合国家哮喘指南的期望。本研究的目的是描述一个大型社区中哮喘患者的急诊科治疗情况。
1996年至1997年期间，对服务于芝加哥大都市地区（六个县）的89家急诊科的医疗主任进行了一项横断面的自我管理调查，以描述哮喘治疗方法。调查主题领域包括哮喘特定的人口统计学和选定的使用统计数据；评估方法；治疗方法；出院和随访活动；以及对指南/方案的熟悉程度、态度和使用情况。
64家急诊科完成了调查，回复率为71.9%。94%的受访者是急诊科医疗主任。作为评估的一部分，虽然峰值流量测量很常见，但使用频率低于脉搏血氧饱和度测定。哮喘治疗的平均（±标准误）住院时间估计为3.0±0.1小时，平均处置时间（即决定住院）为2.5±0.2小时。估计在急诊科就诊期间，73.2±3.9%的患者接受了全身用类固醇（静脉注射或口服）。出院时，55.9±3.5%的患者被开了全身用类固醇。估计只有57.0±5.4%的患者收到了任何类型的哮喘书面教育材料。据报告，约25%的患者在出院时得到了详细的随访预约。
结果显示，医疗主任报告说，芝加哥地区的许多急诊科提供的哮喘治疗与国家指南的关键方面一致。然而，在某些关键的治疗领域，急诊科表现出高度的差异，社区往往未达到指南建议。通过识别哮喘治疗中的这些差异，现在有可能针对芝加哥大都市地区急诊科的全社区哮喘质量改进设定具体目标。
