Each of our participating hospitals reported using an evidence-based approach that incorporated national asthma care guidelines. However, operationalization and documentation of guidelines-based care varied dramatically across participating hospitals. Some hospitals already had well-developed protocols for emergency department asthma care, including both detailed clinical pathways and more holistic approaches incorporating foundational elements of guidelines-based care. By contrast, others had no formal documentation of their asthma management practices for patients seen in the emergency department.
By contrast, we found that utilization of evidence-based supportive services was uniformly high. Specific emergency department asthma care services that appeared to be well developed in Florida were case management, community engagement, and asthma education by certified professionals. We also found that many of the hospitals were in the process of reviewing and documenting their emergency department asthma care practices at the time of our study. Participants noted particular challenges with creating written care plans and dispensing inhaled medications for home use. Following up on the latter issue revealed that Florida state policy on medication use and dispensation in emergency department setting were the main barrier to sending patients with asthma home from the emergency department with needed medications. Consequently, the Florida Asthma Program worked with the state board of pharmacy to implement reforms, which became effective February 2014 [6].
Educational Webinars
Research indicates that quality improvement interventions can improve the outcomes and processes of care for children with asthma [7]. We noted that respondents were often unaware of how other hospitals in the state compared to their own on both national quality measures and strategies for continuous quality improvement. Therefore, promoting dialogue and collaboration became a priority. We developed 2 webinars to allow hospital personnel to learn directly from each other about ways to improve emergency department asthma care. The webinars were open to personnel from any hospital in Florida that wished to attend, not just the hospitals that participated in the initial study.
Florida Asthma Coalition members with clinical expertise partnered with Florida Hospital Association employees and asthma program staff from the Department of Health to design the webinars. Presentations were invited from hospitals that had successfully incorporated EPR-3 guidance into all aspects of their emergency department asthma care and any associated follow-up services. We asked presenters to focus on how their hospitals overcame challenges to successful guideline implementation. During each interactive session, participants had the opportunity to ask questions and receive guidance from presenters and presenters also encouraged hospitals to develop their own internal training webinars and supportive resources for learning, and to share the interventions and materials they created with one another as well as relevant professional organizations.