The Current Care Delivery Practice for Asthma at the Emergency Department in a Tertiary Hospital in Singapore

Abstract

Introduction. Acute exacerbation of asthma is a common condition managed at emergency departments (EDs) globally, and many patients recognize the ED as a major source for their relief. Objectives. This study was done to evaluate the current care delivery practice for asthma at an ED and proposes possible strategies for improvement. Method. A retrospective chart review of all treated and discharged patients who were diagnosed with asthma was conducted between January 1, 2008, and December 31, 2008. Patients were excluded if they had a history of chronic obstructive pulmonary disease and congestive cardiac failure or were admitted for further management. Results. A total of 1303 patients treated and discharged from the ED were included. The mean age of the study population was 36.2 ± 16.2 years; 52.3% were male and 47.7% were female. Forty-eight percent of the patients were treated and discharged with no follow-up. Of those who were given follow-up appointments, 220 (16.9%) were referred to polyclinics and 41 (3.1%) to general practitioners. Ninety-six (7.4%) patients had a relapse within 30 days of discharge from the ED. The median number of days to relapse was 9 days (interquartile range = 3-19 days). Three hundred twenty-three (24.7%) patients re-attended the ED within the 1-year follow-up period. Of these, 252 (19.3%) re-attended ≤2 times and 71 (5.4%) re-attended ≥3 times. Within the follow-up period, 113 (8.7%) patients required admission for further management. Conclusion. There is a need to address gaps in the system and possible strategies have been proposed to improve asthma care for patients seeking treatment at the ED.