Education reduces peds asthma readmits
Experts say programs can be provided by ED
The medical literature shows that educating children and their parents about asthma can reduce return visits to the ED as well as hospital admissions, and experts say that the ED may well be the best place to provide that education.
The Cochrane Library, a London-based publication of The Cochrane Collaboration, an international organization that evaluates health care research, recently reviewed 38 randomized controlled trials involving 7,843 children.1 The authors concluded that educational interventions were effective in reducing the risk of subsequent ED visits by just more than 25% and that educational intervention also resulted in fewer unscheduled doctor visits.
"I think it's great that there is evidence to support this," says Joseph Zorc, MD, an associate professor of pediatrics and emergency medicine and attending physician at The Children's Hospital of Philadelphia. "So many patients come to the ED with their asthma not well managed."
Vincent Wang, MD, associate director of the division of emergency and transport medicine at Children's Hospital of Los Angeles, agrees. Wang adds that the need is even greater today because primary care physicians simply don't have as much time as they did formerly for educating their patient.
Wang and Zorc agree that a one-size-fits-all approach to education will not work. Wang says, "It needs to be customized. There can be some generalization, but every patient has different needs." So, for example, common issues such as causes of asthma and asthma triggers could be made into a single education module, but medications, individual exacerbations, and the method used to teach the patient and the family must be customized. "Basically, when patients come to the ED, they are in different stages of their disease, as is true with any chronic disease," adds Zorc. "They also have different levels of understanding. Many times younger children are just learning, or their parents may just be coming to grips with the fact that their child needs regular preventive medicine. Not everyone is comfortable with that."
The best way to determine those specific needs is to assess the family, he says. How do you make that assessment? "You do it the same way a lot of great clinicians have always done," Zorc says. "You talk to the family and ask a few questions about what they're doing and what they think their child's needs are."
Education given in the ED
Zorc and Wang provided asthma education in their EDs; in fact, Zorc's department has an entire section devoted to asthma treatment. There are six rooms reserved for asthma patients, and they are staffed by respiratory therapists (RTs) and nurse practitioners (NPs). The department also has an observation unit where kids can go for 12-24 hours.
"This is a team approach," Zorc explains. "The RTs spend time with the family, especially focusing on devices and inhalers. The NPs handle the assessments and education."
The department also has created a 10-minute video that patients and their parents can watch in their room. The video addresses common misconceptions about therapies and side effects. "One of the key messages for the ED is that with this disease, you need to go back regularly to your doctor to get good outcomes," says Zorc.
Wang's facility has an asthma action plan — a packet of general information about asthma and specific care the patient has received. Every packet has several common components, and the rest is filled out by the provider based on what the patient requires for immediate care and in the future. "We do not provide inhaled steroids, but we will make a recommendation," notes Wang.
The bottom line, says Zorc, is that "in some sense, an ED visit is a teachable moment, where the family might be open to moving along [in terms of their education]. Your department should do whatever it can do to assess the patient and family and get them back to their regular provider."
Reference
- Haby MM, Waters E, Robertson CF, et al. Interventions for educating children who are at risk for asthma-related emergency department attendance. Cochrane Database Syst Rev 2009; Issue 1. Art. No.: CD001290. Doi: 10.1002/14651858.CD001290.
Sources
For more information on education children with asthma and their families, contact:
- Vincent Wang, MD, Associate Director, Division of Emergency and Transport Medicine, Children's Hospital of Los Angeles. Phone: (323) 361-1856.
- Joseph Zorc, MD, Associate Professor, Pediatrics and Emergency Medicine, The Children's Hospital of Philadelphia. Phone: (215) 590-1000.
Follow-up critical for peds asthma When treating children with asthma, it's important to remember that follow-up is critical, says Vincent Wang, MD, associate director of the division of emergency and transport medicine at Children's Hospital of Los Angeles. Ensuring follow-up entails "recognizing the need for maintenance therapy, and potentially recommending it," he says. However, he advises, an ED manager should caution physicians against taking the place of primary care physicians. "I do not like to start those meds myself," Wang adds. "I prefer to recommend them." |
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