Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
Provider adherence to a clinical practice guideline for acute asthma in a pediatric emergency department
Autore:
Scribano, PV; Lerer, T; Kennedy, D; Cloutier, MM;
Indirizzi:
Univ Connecticut, Sch Med, Connecticut Childrens Med Ctr, Div Emergency Med,Dept Pediat, Hartford, CT 06106 USA Univ Connecticut Hartford CT USA 06106 ept Pediat, Hartford, CT 06106 USA Univ Connecticut, Sch Med, Connecticut Childrens Med Ctr, Gen Clin Res Ctr, Hartford, CT 06106 USA Univ Connecticut Hartford CT USA 06106 in Res Ctr, Hartford, CT 06106 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 12, volume: 8, anno: 2001,
pagine: 1147 - 1152
SICI:
1069-6563(200112)8:12<1147:PATACP>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
PHYSICIANS; CHILDREN; CARE; IMPLEMENTATION; IMPROVEMENT; MANAGEMENT;
Keywords:
clinical practice guidelines; asthma; adherence; emergency care;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Scribano, PV Univ Connecticut, Sch Med, Connecticut Childrens Med Ctr, DivEmergency Med,Dept Pediat, 282 Washington St, Hartford, CT 06106 USA Univ Connecticut 282 Washington St Hartford CT USA 06106 USA
Citazione:
P.V. Scribano et al., "Provider adherence to a clinical practice guideline for acute asthma in a pediatric emergency department", ACAD EM MED, 8(12), 2001, pp. 1147-1152

Abstract

Critics of the use of clinical practice guidelines (CPGs) in an emergency department (ED) setting believe that they are too cumbersome and time-consuming, but to the best of the authors' knowledge, potential barriers to CPG adherence in the ED have not been prospectively evaluated. Objectives: To measure provider adherence to an ED CPG based on National Asthma Education and Prevention Program (NAEPP) recommendations, and to determine factors associated with provider nonadherence, Methods: Prospective, cohort study of children aged 1-18 years with the diagnosis of an acute exacerbation of asthma who were seen in a pediatric ED and requiring admission, as well as a random selection of children discharged to home following pediatric ED care. The following adherence parameters were assessed: at least three nebulized albuterol treatments in the first hour; early steroid administration (afterthe first nebulizer treatment); clinical assessments using pulse oximetry and peak expiratory flow (PEF) (for children >6 years old); and use of a clinical score to assess acute illness severity (Asthma Severity Score). Nonadherence was defined as any deviation of the above parameters. Results: Between July 1, 1998, and June 30, 1999, 369 patients were studied. Of these, 38% (139) were discharged to home, 38% (140) were admitted to the observation unit, and 24% (90) were admitted to the inpatient unit. Illness severities at initial presentation to the ED were: 24% (86) had mild exacerbations,59% (212) had moderate exacerbations, and 17% (62) had severe exacerbations. Sixty-eight percent (95% CI = 63% to 73%) of the patients were managed with complete adherence to the CPG. Of the 32% with some form of nonadherence, most (63%) were children older than 6 years; in this group 64% (48/75) were nonadherent due to lack of PEF assessment. When PEF assessment was disregarded, an 83% (95% Cl = 79% to 87%) adherence to the CPG was achieved. Other nonadherence factors included: lack of at least three nebulized albuterol treatments provided timely within the first hour (5%); delay in steroid administration (6%); lack of pulse oximeter use (0.5%); and failure to record clinical score to assess severity (1.1%). Patient age, illness severity (acute and chronic), first episode of wheezing, and high ED volume periods (evenings and weekends) did not worsen adherence. Conclusions: Clinical practice guidelines can be used successfully in the pediatric ED and provide amore efficient management and treatment approach to acute exacerbations ofchildhood asthma. With a systematic and concise CPG, barriers to adherencein a pediatric ED appear to be minimal, with the exception of using PEF inthe routine ED assessment.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 31/03/20 alle ore 10:36:20