Determinants of asthma-related emergency department return visits in adults: a population-based study

Rationale — Emergency department (ED) return-visit rates provide a measure of the quality of acute asthma care.

Objectives — We sought to assess the impact of patient and site characteristics, including asthma management strategies, on return visits within 72 hours, prior to implementation of a standardized adult ED asthma care pathway in EDs throughout Ontario, Canada.

Methods — This population-based cohort study utilized comprehensive administrative health data from the Institute for Clinical Evaluative Sciences for adults 20 to 64 years old who had at least one ED visit for asthma from April 1, 2006 to March 31, 2008. Detailed information on ED management strategies was available on a subset of 37 sites whose staff attended pathway implementation workshops.

Measurements and Main Results — A total of 41,140 asthma visits to 167 EDs were analyzed. Most patients (64.8%) were triaged as high acuity and the majority (92.8%) were discharged. The return-visit rate was 2.8%. Female gender, younger age, higher acuity, leaving the ED before visit completion and prior admission or ED visit for asthma were associated with increased odds of a return visit. The only management strategy associated with reduced ED visits was access to 24-hour peak flow measurement.

Conclusion — This study identified well-recognized patient- and hospital-level risk factors for return ED visits. Access to peak flow monitoring was the only protective management strategy found. As many ED asthma service and care gaps exist, province-wide implementation of a standardized care pathway may greatly impact ED management and improve patient outcomes including return ED visits.