Implementation of an Asthma Self-Management Education Guideline in the Emergency Department: A Feasibility Study

Where Do We Stand on Cervical Spine Immobilisation? A Questionnaire among Prehospital Staff

Background: Cervical collars (CC) are routinely used in prehospital trauma treatment. However, over the past years, their application was discussed more critically since they increase intravenous pressure due to reduced venous drainage and the possibility of secondary cervical spine injury. Guidelines have been adjusted accordingly. The question is how efficient has this been put into practice, and how good, as well as up to date, is the knowledge of prehospital emergency medicine personnel about indications on cervical spine immobilisation? Methods: A 15-item questionnaire regarding the self-evaluation and result checking of the right indications for the use of a cervical collar in the prehospital setting was sent to paramedics and emergency doctors in Germany. Two hundred and nineteen completed surveys were statistically analysed. Results: Mean age of the participants was 30.45 ± 8.8. 72% were male. Regarding subjective safety, the appropriate indication of CC participants reached 79.8 ± 19.5 on a metric scale from 0 (no safety) to 100 (full safety). Mean right answers were as follows: Ambulance man (RS) 0.78 ± 0.84, paramedic (RA) 0.9 ± 0.74, paramedic (NFS) 1.03 ± 0.83 and emergency doctor (ED) 1.75 ± 1.06 (p = 0.013, Kruskal-Wallis Test). Participants who estimated their knowledge < 85% had 0.83 ± 0.8 right answers, and > 85% had 1.14 ± 0.9 right answers. Conclusions: Rational spine immobilisation is still necessary in severely injured patients. This study highlights the importance of continuing education using ongoing training, lectures or online learning with a questionnaire as a monitor for success to ensure the transfer of evidence-based medicine into daily practice.

Understanding interventions delivered in the emergency department targeting improved asthma outcomes beyond the emergency department: an integrative review

OBJECTIVES

The emergency department (ED) represents a place and moment of opportunity to provide interventions to improve long-term asthma outcomes, but feasibility, effectiveness and mechanisms of impact are poorly understood. We aimed to review the existing literature on interventions that are delivered in the ED for adults and adolescents, targeting asthma outcomes beyond the ED, and to code the interventions according to theory used, and to understand the barriers and facilitators to their implementation.

METHODS

We systematically searched seven electronic databases and research registers, and manually searched reference lists of included studies and relevant reviews. Both quantitative and qualitative studies that reported on interventions delivered in the ED which aimed to improve asthma outcomes beyond management of the acute exacerbation, for adolescents or adults were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool and informed study interpretation. Theory was coded using the Theoretical Domains Framework. Findings were summarised by narrative synthesis.

RESULTS

12 articles were included, representing 10 unique interventions, including educational and medication-based changes (6 randomised controlled trials and 4 non-randomised studies). Six trials reported statistically significant improvements in one or more outcome measures relating to long-term asthma control, including unscheduled healthcare, asthma control, asthma knowledge or quality of life. We identified limited use of theory in the intervention designs with only one intervention explicitly underpinned by theory. There was little reporting on facilitators or barriers, although brief interventions appeared more feasible.

CONCLUSION

The results of this review suggest that ED-based asthma interventions may be capable of improving long-term outcomes. However, there was significant variation in the range of interventions, reported outcomes and duration of follow-up. Future interventions would benefit from using behaviour change theory, such as constructs from the Theoretical Domains Framework.

PROSPERO REGISTRATION NUMBER

CRD 42020223058.

Identification of caregiver's knowledge and perceptions of pediatric asthma management: A quality improvement initiative

INTRODUCTION

Asthma is the most prevalent chronic disease of childhood. Caregiver knowledge is essential to optimize patient quality and safety. Asthma education is an opportunity that can lead to decreased morbidity and mortality, reduced admission rates, lower cost, and improved outcomes for a child with chronic asthma.

OBJECTIVE

The purpose of this quality improvement study was to obtain information from caregivers of children with asthma to gain insight into their knowledge gaps and needs as a critical first step towards the provision of patient centered effective and efficient care.

METHODS

This was a descriptive educational knowledge assessment conducted using questionnaires via a hand-held electronic device (iPad).

RESULTS

All caregivers in this study reported that they desired more education. Specific knowledge deficits were identified and included: understanding the pathophysiology of asthma, mechanism of action of use of medications including both rescue and maintenance agents, and initial actions to implement during an acute asthma exacerbation.

CONCLUSION

Caregivers in this sample population had a suboptimal understanding of the asthma disease process and home management strategies.

PRACTICE IMPLICATIONS

To maximize education strategies and achieve symptom control and risk reduction in the care of children with asthma, it is imperative that caregivers clearly understand asthma home management and actively participate in all aspects of their child's care. The identification of specific gaps and needs in caregiver's knowledge base is a critical first step towards the provision of patient-centered effective and efficient pediatric asthma care.

Leveraging the Electronic Medical Record to Increase Distribution of Low Literacy Asthma Education in the Emergency Department

OBJECTIVE

Though low literacy asthma education is effective at reducing emergency department (ED) use, few interventions are administered in the ED. The aim was to increase the number of parents of children with asthma receiving education in the ED to 50% receiving written and 30% receiving video education over 12 months.

METHODS

Using quality improvement methods, the team planned interventions including improvement of nursing workflow and availability of written and video education. Nurse champions performed peer-to-peer education regarding educational materials and health literacy-focused communication. An asthma education order opening the nursing flowsheet, which linked to written and video materials and documentation was created. The order was placed in highly used ED asthma order sets. The percent of parents receiving written or video education was followed on statistical process control charts. Balancing measures included: ED length of stay, discharge length, 30 day ED return visits, and 365 day return visits with hospitalization.

RESULTS

The mean number of parents receiving written education at baseline was 28% and improved to 52%. Special cause variation was noted after order roll-out. Video education increased from a baseline of 0% of parents receiving to 32% with special cause variation after order roll-out. No special cause was noted in balancing measures. Revisits with hospitalization within 365 days showed a decreasing trend after order roll-out.

CONCLUSIONS

Implementation of workflow improvement, education, and the addition of a functional education order in an existing order set led to a meaningful improvement in distribution of a low literacy asthma education intervention.