Multicenter Airway Research center and ED

October 17, 2014 admin Erectile Disfunction

The most notable gaps in ED care were: (1) underutilization of spirometry or PEFR to either assess the severity of the exacerbation at presentation to the ED or to assess suitability of discharge home; (2) underutilization of systemic steroids both in the ED and on discharge; and (3) failure at the time of discharge to refer the majority of these high-risk individuals to specialized asthma services. Although guidelines do not recommend routine CXRs, they were done in 30 to 43% of cases—on average, as often as or more often than PEFR measurements.

Improvement in this aspect of the management of severe acute asthma may reduce the costs incurred by potentially unnecessary investigations and improve resource allocation. The care gaps noted are substantially larger than a recent report of Canadian centers participating in the Multicenter Airway Research collaboration and are likely more representative of average Canadian Viagra pharmacy EDs. Of particular concern are the considerable practice variations between centers, an observation not previously reported. If use of steroids and referrals could be increased, patient outcomes and relapse rates might improve.

Reasons for the variations in care gaps between institutions are not known. Potential explanations include regional differences in access to services (such as spirometry in the ED or specialists in the community), knowledge of emergency asthma management guidelines and recent literature, the presence of standardized order sets and automatic referrals, and attitudes and beliefs of health-care providers regarding aspects of care such as the merits of education in ED and indications for referral.

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The correlation between various management practice patterns (eg, systemic steroids in ED, systemic steroids on discharge, and use of PEFR) suggests certain sites were performing better in general. Multilevel modeling that controls for potential confounders is warranted to determine patient, site, and management characteristics associated with the best outcomes.