A Computerized Asthma Management System in the Pediatric Emergency Department
| Status: | Completed |
|---|---|
| Conditions: | Asthma, Hospital |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases, Other |
| Healthy: | No |
| Age Range: | 2 - 28 |
| Updated: | 8/19/2018 |
| Start Date: | October 2010 |
| End Date: | December 7, 2015 |
The primary goal of this study is that the combination of a computerized asthma reminder
system with implementation of an guideline will increase utilization and adherence of
guideline-driven care, leading to improved patient outcomes.
Hypothesis: An automatic, computerized reminder system for detecting asthma patients in the
pediatric ED will increase guideline adherence compared to paper-based guideline.
The specific aims of the study are:
Aim 1: Develop, implement, and integrate the asthma guideline in the ED information system
infrastructure.
Aim 2: Evaluate the effect of the asthma detection system combined with the computerized
guideline versus the asthma detection system combined with the paper-based guideline.
system with implementation of an guideline will increase utilization and adherence of
guideline-driven care, leading to improved patient outcomes.
Hypothesis: An automatic, computerized reminder system for detecting asthma patients in the
pediatric ED will increase guideline adherence compared to paper-based guideline.
The specific aims of the study are:
Aim 1: Develop, implement, and integrate the asthma guideline in the ED information system
infrastructure.
Aim 2: Evaluate the effect of the asthma detection system combined with the computerized
guideline versus the asthma detection system combined with the paper-based guideline.
Asthma is the leading chronic childhood disease affecting 9 million children (12.5%) under 18
years of age (1). Asthma exacerbations cause an estimated 14 million missed school days (2)
and more than 1.8 million emergency department (ED) visits annually (2), and account for >60%
of asthma-related costs (3). The chronic characteristic of asthma carries a considerable
economic burden.
Uncontrolled asthma can lead to exacerbations requiring the patient to seek immediate care,
frequently in an ED setting. Several asthma guidelines, including the nationally accepted
guideline from the National Heart, Lung, and Blood Institute (NHLBI), exist to support
clinicians in providing adequate treatment. Utilization of and adherence with asthma
guidelines improves patients' clinical care (4, 5). However, guideline adherence remains
suboptimal. In the ED, early recognition and accurate assessment of the severity of airway
obstruction and response to therapy are fundamental to the improvement of health for patients
with asthma. The NHLBI guidelines emphasize early recognition and treatment of asthma
exacerbations, as well as appropriate treatment stratified by severity.
Computer applications for patient care can address barriers to optimal medical care. Computer
systems have improved the use and adherence to practice guidelines, provide clinical alerts
and reminders, and generate patient-specific treatment recommendations and educational
material. Implementation of guideline-driven decision support is frequently paper-based or
computerized. In either form a major barrier remains on the busy clinicians to remember to
initiate the guideline a process and to embed the guideline tasks in the clinical workflow of
the care team (5). The proposed study examines the benefits of a novel approach for reminding
clinicians in an ED setting to use guideline-driven care. The approach will apply a
workflow-embedded process taking advantage of an advanced information technology
infrastructure. The informatics approach will include two elements: a) a computerized,
real-time reminder system, which will automatically detect guideline-eligible patients
without requiring additional data entry, and b) a computerized, workflow-embedded guideline
implementation.
years of age (1). Asthma exacerbations cause an estimated 14 million missed school days (2)
and more than 1.8 million emergency department (ED) visits annually (2), and account for >60%
of asthma-related costs (3). The chronic characteristic of asthma carries a considerable
economic burden.
Uncontrolled asthma can lead to exacerbations requiring the patient to seek immediate care,
frequently in an ED setting. Several asthma guidelines, including the nationally accepted
guideline from the National Heart, Lung, and Blood Institute (NHLBI), exist to support
clinicians in providing adequate treatment. Utilization of and adherence with asthma
guidelines improves patients' clinical care (4, 5). However, guideline adherence remains
suboptimal. In the ED, early recognition and accurate assessment of the severity of airway
obstruction and response to therapy are fundamental to the improvement of health for patients
with asthma. The NHLBI guidelines emphasize early recognition and treatment of asthma
exacerbations, as well as appropriate treatment stratified by severity.
Computer applications for patient care can address barriers to optimal medical care. Computer
systems have improved the use and adherence to practice guidelines, provide clinical alerts
and reminders, and generate patient-specific treatment recommendations and educational
material. Implementation of guideline-driven decision support is frequently paper-based or
computerized. In either form a major barrier remains on the busy clinicians to remember to
initiate the guideline a process and to embed the guideline tasks in the clinical workflow of
the care team (5). The proposed study examines the benefits of a novel approach for reminding
clinicians in an ED setting to use guideline-driven care. The approach will apply a
workflow-embedded process taking advantage of an advanced information technology
infrastructure. The informatics approach will include two elements: a) a computerized,
real-time reminder system, which will automatically detect guideline-eligible patients
without requiring additional data entry, and b) a computerized, workflow-embedded guideline
implementation.
Inclusion Criteria:
- all patients aged 2-18 years
- Emergency Severity Index 2 to 5
- availability of completed computerized triage documentation.
Exclusion Criteria:
- critically ill patients (Emergency Severity Index 1)
- patients who leave-without-being seen
- patients who leave against-medical-advice
- patients whose final diagnosis was not asthma (false positive identification by the
detection system) or were determined not to be eligible for the guideline.
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Vanderbilt Children's Hospital Monroe Carell Jr. Children's Hospital at Vanderbilt is one of the nation's...
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