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Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

Published online by Cambridge University Press:  04 March 2015

Pat G. Camp ,
Seamus P. Norton ,
Ran D. Goldman ,
Salomeh Shajari ,
M. Anne Smith ,
Susan Heathcote  and
Bruce Carleton
Pat G. Camp
Affiliation:
James Hogg Research Centre, University of British Columbia, Vancouver, BC Department of Physical Therapy, University of British Columbia, Vancouver, BC
Seamus P. Norton
Affiliation:
Department of Pediatrics, McMaster University, Hamilton
Ran D. Goldman
Affiliation:
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, BC Department of Pediatrics, University of British Columbia, Vancouver, BC
Salomeh Shajari
Affiliation:
Pharmaceutical Outcomes Programme, Child&Family Research Institute; Vancouver, BC
M. Anne Smith
Affiliation:
Pharmaceutical Outcomes Programme, Child&Family Research Institute; Vancouver, BC
Susan Heathcote
Affiliation:
Quality and Risk Management, BC Children’s Hospital, Vancouver, BC
Bruce Carleton
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, BC Pharmaceutical Outcomes Programme, Child&Family Research Institute; Vancouver, BC

Abstract

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Objective:

Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months.

Results:

A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child’s asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child’s future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child’s asthma.

Conclusion:

Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations.

Keywords

asthmaexacerbationpediatric
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 6 , November 2014 , pp. 467 - 476
Copyright
Copyright © Copyright © Canadian Association of Emergency Physicians 2014

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