Hospitals can do better to help kids with asthma

    TORONTO, Dec. 3 /CNW/ - Affecting half a million children in Canada,
asthma is the most common chronic disease of childhood. It's also one of the
top reasons why kids visit Emergency Departments (EDs). As the busiest season
for EDs approaches, a new study led by researchers from Ontario's Institute
for Clinical Evaluative Sciences (ICES) finds better strategies are needed by
EDs to prevent return asthma visits that in many cases are unnecessary.
    Published in the December issue of Pediatrics, ICES research examined
data from all 152 EDs in Ontario. Children aged 2-17 years were studied who
had a visit to an ED for asthma between 2003 and 2005. The objective was to
describe the current asthma management strategies for children used by EDs in
the province of Ontario and to test which strategies have an impact on return
visits in children. Lead Author and ICES Scientist, Dr. Astrid Guttmann says,
"we wanted to look at the quality of emergency department care for a common
disease, asthma for which we have good knowledge about assessment and
treatment but less about how to translate that knowledge to practice. We
looked at the bounce backs, the cases returning to emergency within 72 hours.
This is a good measure how EDs are doing and what kind of care these children
are getting. There is room for improvement."

    The results:

    -   Nearly 35,000 children had at least one visit to an ED for care of
        asthma and more than half were triaged as high acuity.
    -   97% of EDs reported using at least one asthma management strategy and
        74% used three or more.
    -   Of the nearly 28,000 children discharged home after a complete ED
        visit 5.6% had a return visit within 72 hours, with the highest rate
        in small community hospitals (7.1%).
    -   Over two-thirds of children who returned were triaged as urgent with
        a subsequent admission rate of 16.6%.
    -   Pre-printed standardized order sets and access to a pediatrician for
        consultation were the only strategies significantly reducing return
        visits; EDs using both of these strategies had return visits of 4.4%
        compared to 6.9% in those that used neither.
    -   Having guidelines alone in the ED did not have an impact on return

    Co-author and Sr. ICES Scientist, Dr. Geoff Anderson says, "having a
pediatrician accessible may be difficult to implement but a pre-printed order
set is equally effective at decreasing return visits. Order sets are a roadmap
to the care of the patient, used by physicians to order medications,
treatments, procedures and consultations for each individual. They are
structured, may reduce errors and ensure protocols are accurately followed,
but only 17 of the 152 Ontario emergency departments are using them. This
study suggests, these tools can improve outcomes for children with asthma."
    Asthma is a chronic inflammatory disorder of the airways that causes
wheezing, chest pains and difficulty breathing. The exact cause is not known,
but the illness is believed to come from a combination of genetics and
environmental factors. Relief comes with the use of inhalers or puffers
containing drugs to help relax the airways and reduce inflammation, or oral
medication in some cases. Asthma is the leading cause of school absences and
one of the leading causes of hospitalizations in children.
    "Almost 10% of children with asthma will seek care in emergency any given
year. Once you hit an emergency room what predicts good care? Without
standardized care, children seen in some ER's may have worse outcomes than
children seen in others. We have an opportunity to implement best practices,
through standardized order sets - It's clear what needs to be done", says Dr.

    The study Effectiveness of Emergency Department Asthma Management
Strategies on Return Visits in Children: A Population-based Study is in the
December issue of Pediatrics.

    Author affiliations: ICES (Drs. Guttmann, Schull, Anderson, Austin
and To, Mr. Zagorski, Ms. Razzaq); Division of Paediatric Medicine, Hospital
for Sick Children (Dr. Guttmann); Dept. of Paediatrics, University of Toronto
(Dr. Guttmann); Dept. of Health Policy, Management and Evaluation, University
of Toronto (Drs. Guttmann, Schull, Anderson, Austin, To); Child Health
Evaluative Sciences, Research Institute, The Hospital for Sick Children, (Drs.
Guttmann, To); Dept. of Public Health Sciences, University of Toronto (Drs.
Austin, To); Division of Emergency Medicine, Faculty of Medicine, University
of Toronto (Dr. Schull); Toronto, Ontario.

    ICES is an independent, non-profit organization that uses
population-based health information to produce knowledge on a broad range of
health care issues. Our unbiased evidence provides measures of health system
performance, a clearer understanding of the shifting health care needs of
Ontarians, and a stimulus for discussion of practical solutions to optimize
scarce resources. ICES knowledge is highly regarded in Canada and abroad, and
is widely used by government, hospitals, planners, and practitioners to make
decisions about care delivery and to develop policy.

For further information:

For further information: Media Contact: Kristine Galka, Media Advisor,
ICES, (416) 480-4780, or cell (416) 629-8493,

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