Research Article
Volume 11 Issue 1 - 2022
A Retrospective Study on Clinical Outcomes of the Asthma and COPD Clinical Pathway in the Management of Asthma Exacerbations in the Emergency and Trauma Department of Hospital Kuala Lumpur
Teoh Wen IM1*, Hidayah Binti Shafie2 and Ahmad Zulkarnain Bin Ahmad Zahedi3
1Medical Officer, Emergency and Trauma Department, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan, Malaysia
2Consultant Emergency Physician, Emergency and Trauma Department, Hospital Kuala Lumpur, Malaysia
3Emergency Physician, Faculty of Medicine Dean’s Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
*Corresponding Author: Teoh Wen IM, Medical Officer, Emergency and Trauma Department, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
Received: December 06, 2021; Published: December 31, 2021




Abstract

Background: Implementation of asthma clinical pathways has been found to reduce the length of stay (LOS), improve outcomes, and minimize the burden on emergency departments (ED). The ED of Hospital Kuala Lumpur receives about 50 - 70 patients with asthma exacerbations daily. The Asthma and Chronic Obstructive Pulmonary Disease (COPD) Clinical Pathway (ACCP) was introduced in 2015 to optimize the management of asthma and COPD.

Objective: To assess the clinical outcomes of ACCP for management of asthma exacerbations.

Methodology: We retrospectively reviewed the case notes of patients with asthma exacerbations, aged 5 - 65 years, who received treatment before (July 2015-October 2015; pre-pathway) and after (October 2015-January 2016; post-pathway) the implementation of ACCP in the ED of Hospital Kuala Lumpur. The primary endpoints were rate of referral from ED to follow-up centers, and rate of return visits to ED within 72 hours, before and after implementation of ACCP. Secondary endpoints included LOS, hospitalization rate, and use of systemic corticosteroids/bronchodilator therapy, before and after implementation of ACCP.

Results: Of the 1083 asthma case notes screened, 800 were considered for the study (pre-pathway: 46.3%, post-pathway: 53.7%). A significantly higher percentage of patients were given proper referral upon discharge in the post vs. pre-pathway groups (24.7% vs. 11.9%; p = 0.001). There was no significant difference in the rate of return visits, hospitalization rate, LOS, or frequency of bronchodilator use between the two groups. Use of systemic corticosteroids was significantly higher in the post- vs. pre-pathway groups (37.2% vs. 17.8%; p < 0.05).

Conclusion: Implementation of ACCP in the ED of Hospital Kuala Lumpur for management of asthma exacerbations may enhance the rate of referral and rate of administration of corticosteroids in asthma cubicles. Use of educational interventions in future may help further improvise the impact of ACCP for the management of asthma exacerbations.

Keywords: Asthma; Clinical Pathways; Emergency Department; Malaysia

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Citation: Teoh Wen IM., et al. “A Retrospective Study on Clinical Outcomes of the Asthma and COPD Clinical Pathway in the Management of Asthma Exacerbations in the Emergency and Trauma Department of Hospital Kuala Lumpur”. EC Pulmonology and Respiratory Medicine 11.1 (2022): 70-81.

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