Asthma clinics: Chest pain centers of the future?
Asthma centers may become the chest pain centers of the future, as EDs increasingly target this patient population. Brookwood Medical Center in Birmingham, AL, opened its Asthma Continuing Care Clinic three months ago to address education needs of patients. "We are changing the way we are treating patients who come in with asthma, using the same philosophy as we do with chest pain patients," says Jackie Dillard, RN, operation leader for emergency services.
When asthma patients enter the ED, their peak flows are immediately monitored. "We have a standing protocol where nurses do the majority of the work before the physician actually comes in," says Dillard.
When asthma patients are discharged from the ED or the hospital, they are referred to the asthma clinic, which is connected to the ED by a walkway. "Instead of just treating them and wishing them well [and] assuming they’ll see a private physician, they also have this opportunity to learn how to keep themselves out of the ED," says Dillard.
Although patients are educated about peak flows and diary-keeping in the ED, more extensive education is needed when the urgency passes. "When you’re in distress, that’s not a good learning time," says Dillard. "The patient needs to understand what is causing them to go into respiratory distress, and they need to be taught at a time when they can truly retain what they learn."
At the clinic, patients are given extensive education--including tips on avoiding asthma triggers, making environmental modifications, and possible drug interactions—with the goal of preventing unnecessary ED visits and hospitalizations, says Donna Smaha, RN, MSN, the asthma program coordinator/outcomes manager. "We show patients that if they monitor peak flows regularly, they can actually determine a problem up to four days before symptoms actually begin, which prevents acute exacerbation," she reports.
For EDs in urban facilities such as Chicago’s Cook County Hospital, asthma clinics are primarily used to streamline patient flow. "We have a tremendous census of asthma patients that seems to be increasing," reports Mary Pollock, RN, a nurse practitioner in Cook County’s ED. "Roughly 50% of them have had asthma all their lives, but a significant number have developed it recently."
The ED’s asthma clinic gets asthma patients out of the ED waiting room and into a separate area, where treatment is started immediately. "We observe the more severe patients for up to eight hours, and if they are still bad, they will be admitted," says Pollock. Because there is not time to do extensive teaching in the ED, patients are referred to the hospital clinic for additional education, she explains.
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