Asthma Action Plans in the Emergency Department for Low Acuity Pediatric Patients

Abstract

Problem: At one local community emergency department (ED) in the Mid-Atlantic area, pediatric patients presenting for an asthma complaint that do not require hospital admission received no tailored education upon discharge from their ED visit. Published evidence supports distributing asthma action plans (AAPs) from the ED setting to improve asthma control, increase understanding of asthma, and decrease ED utilization. Purpose: The purpose of this quality improvement (QI) initiative was to implement AAPs upon discharge from the ED for these patients over a 15-week period in the fall of 2022. Methods: The QI Project Lead (QIPL) mobilized an interdisciplinary team of stakeholders at the project site to plan evidence-based structure and workflow changes, including documentation of patient heights for tailored peak flow measurements, an integral component to AAPs. Patients were offered an AAP if they were discharged from the ED after being seen for an asthma related complaint and were between the ages of 2 and 17 without structural lung disease. Data was collected weekly on the number of patients who had a height documented during their visit, teaching of peak flow, and receipt of an AAP at discharge. Results: A total of 41 patients presented meeting inclusion criteria. 7% had peak flow documented, 15% had a documented height, and 7% had an AAP given upon discharge. 78% of patients meeting inclusion criteria tested positive for a viral infection during their ED visit. Data noted fallouts on AAP distribution for the many patients presenting with concurrent viral infections. Conclusions: Findings suggest that project adherence is contingent in part upon unit census and acuity, as well as an automated method to remind providers to distribute AAPs. Ongoing discussion is also warranted with pediatric providers to discuss goals of care specifically for patients with an asthma exacerbation triggered by respiratory infections.