Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department. (May 2020)

• Record Type: Journal Article
• Authors: Mowbray, Fabrice I.; DeLaroche, Amy M.; Parker, Sarah J.; Jones, Aaron; Ravichandran, Yagnaram
• Is Part Of: International emergency nursing. Volume 50(2020)
• Publication Date: 2020-05
• Subjects: Nurse practitioner -- Pediatric -- Children -- Asthma -- Emergency department -- Staffing models; Emergency nursing -- Periodicals; 616.025
• DOI: 10.1016/j.ienj.2020.100844
• Languages: English
• ISSNs: 1755-599X

Abstract

Abstract: Background: Little is known about the clinical management or quality of asthma care provided by nurse practitioners (NP) in a pediatric emergency setting. Objective: To describe the clinical management of asthma by NPs in our institution's emergency department, and to compare the treatment strategies between NPs, pediatricians, and pediatric emergency physicians. Methods: We conducted a retrospective chart review at a level-one pediatric trauma center. Data were extracted from electronic medical records for all patients between 2 and 18 years of age presenting to the emergency department with an asthma exacerbation. Data were analyzed using binary logistic regression with generalized estimating equations. Results: NPs evaluated 18% of all children presenting for asthma care. When compared to pediatric emergency physicians, patients treated by NPs had approximately twice the odds of receiving a β2-agonist (OR = 2.02; 95% CI 1.02 – 3.99) or a systemic corticosteroid (OR = 2.31; 95% CI 1.35 – 3.95) within 60 minutes of clinical evaluation. Adherence rates were similar for the other asthma quality measures between these two clinician groups. Conclusions: NPs were best able to meet time-sensitive asthma quality measures in the emergency department. The addition of NPs to emergency staffing models may improve access to timely care for children with asthma.