An asthma management system in a pediatric emergency department

Judith W. Dexheimer, Thomas J. Abramo, Donald H. Arnold, Kevin B. Johnson, Yu Shyr, Fei Ye, Kang Hsien Fan, Neal Patel, Dominik Aronsky

研究成果: Article同行評審

18 引文 斯高帕斯(Scopus)

摘要

Introduction: Pediatric asthma exacerbations account for >1.8 million emergency department (ED) visits annually. Asthma guidelines are intended to guide time-dependent treatment decisions that improve clinical outcomes; however, guideline adherence is inadequate. We examined whether an automatic disease detection system increases clinicians' use of paper-based guidelines and decreases time to a disposition decision. Methods: We evaluated a computerized asthma detection system that triggered NHLBI-adopted, evidence-based practice to improve care in an urban, tertiary care pediatric ED in a 3-month (7/09-9/09) prospective, randomized controlled trial. A probabilistic system screened all ED patients for acute asthma. For intervention patients, the system generated the asthma protocol at triage for intervention patients to guide early treatment initiation, while clinicians followed standard processes for control patients. The primary outcome measures included time to patient disposition. Results: The system identified 1100 patients with asthma exacerbations, of which 704 had a final asthma diagnosis determined by a physician-established reference standard. The positive predictive value for the probabilistic system was 65%. The median time to disposition decision did not differ among the intervention (289. min; IQR = (184, 375)) and control group (288. min; IQR = (185, 375)) (p= 0.21). The hospital admission rate was unchanged between intervention (37%) and control groups (35%) (p= 0.545). ED length of stay did not differ among the intervention (331. min; IQR = (226, 581)) and control group (331. min; IQR = (222, 516)) (p= 0.568). Conclusion: Despite a high level of support from the ED leadership and staff, a focused education effort, and implementation of an automated disease detection, the use of the paper-based asthma protocol remained low and time to patient disposition did not change.

原文English
頁(從 - 到)230-238
頁數9
期刊International Journal of Medical Informatics
82
發行號4
DOIs
出版狀態Published - 2013 四月

All Science Journal Classification (ASJC) codes

  • Health Informatics

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