Abstract
PURPOSE: Pediatric asthma exacerbation guidelines were implemented in the emergency department (ED) of the Songklanagarind Hospital in March 2021. The primary outcome was physician adherence to the guideline. Secondary outcomes included comparisons of selected ED quality indicators. PATIENTS AND METHODS: This single-center retrospective before-after study included children aged <15 years who presented with asthma exacerbation at the ED. Data were collected before guideline implementation (January 1, 2020, to February 28, 2021) and after implementation (March 1, 2021, to December 31, 2022). Guideline adherence was described as proportions. Between-period comparisons were analyzed using multivariable logistic regression to estimate odds ratios with 95% confidence intervals (CI). RESULTS: A total of 313 pediatric patients met the inclusion criteria with 135 and 178 patients in the pre-and post-guideline groups, respectively. Overall adherence to the guidelines was approximately 42.1%. After implementation, patients were more likely to have scheduled outpatient follow-up on the next calendar business day (adjusted OR 4.82, 95% CI 2.33-10.38) and less likely to be admitted to the hospital (adjusted OR 0.30, 95% CI 0.11-0.76). CONCLUSION: Following the introduction of the guidelines in the ED, physician adherence was partial and was associated with significant improvements in some aspects of care quality. Ongoing review, feedback, education, and monitoring of time-sensitive care processes may help sustain and further improve the care of children with asthma exacerbations.