Section of Emergency Medicine, Department of Pediatrics, and
Medical College of Wisconsin, Milwaukee, Wisconsin.
Pediatrics. 2016 Nov;138(5). doi: 10.1542/peds.2015-3339.
Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores.
The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement. Time series analysis was performed and outcomes assessed on statistical process control charts.
Asthma severity scoring increased from 0% to >95% in triage and to >75% for repeat scores. Time to first SABA (T1) improved by 32.8 minutes (47%). T1 for low severity patients improved by 17.6 minutes (28%). T1 for high severity patients improved by 3.1 minutes to 18.1 minutes (15%). Time to third SABA (T3) improved by 30 minutes (24%). T3 for low severity patients improved by 42.5 minutes (29%) and T3 for high severity patients improved by 21 minutes (23%). Emergency department length of stay for low severity patients discharged to home improved by 29.3 minutes (15%). The number of asthma-related visits between 48-hour return hospitalizations increased from 114 to 261. The admission rate decreased 6.0%.
We implemented standardized asthma severity scoring with high rates of compliance, improved timely administration of β-agonist treatments, demonstrated early improvements in Emergency department length of stay, and reduced admission rates without increasing unplanned return admissions.
短效β激动剂（SABA）的快速重复给药是减少哮喘急性气流阻塞的最有效方法。几乎没有证据评估哮喘的过程指标（即及时性）和结果。我们使用质量改进（QI）方法，根据国家指南改善急诊科的护理，包括及时给予 SABA 和使用哮喘严重程度评分。
使用改进模型，干预措施针对 4 个关键驱动因素：知识、参与度、决策支持和工作流程增强。进行时间序列分析，并在统计过程控制图上评估结果。
在分诊中，哮喘严重程度评分从 0%增加到>95%，重复评分>75%。首次 SABA（T1）时间缩短了 32.8 分钟（47%）。轻度严重患者的 T1 缩短了 17.6 分钟（28%）。重度严重患者的 T1 从 3.1 分钟缩短至 18.1 分钟（15%）。第三次 SABA（T3）时间缩短了 30 分钟（24%）。轻度严重患者的 T3 缩短了 42.5 分钟（29%），重度严重患者的 T3 缩短了 21 分钟（23%）。低严重程度患者出院回家的急诊科停留时间缩短了 29.3 分钟（15%）。48 小时内返回医院的哮喘相关就诊次数从 114 次增加到 261 次。入院率降低了 6.0%。
我们实施了标准化的哮喘严重程度评分，具有高合规率，提高了β激动剂治疗的及时性，早期缩短了急诊科停留时间，并降低了入院率，而没有增加计划外返回就诊。
