Phase 1 – Project Research and Development
To develop an electronic clinical documentation interface that utilizes current evidence and guidelines and incorporates clinical decision support.
(Number etc). A multidisciplinary collaborative approach will be used with the following resources

• Emergency physician/Team Leader
• Emergency Medicine trainee
• Respiratory physician
• Health information technology experts
• Emergency department data manager
• Respiratory nurse specialist
• Senior emergency nursing staff

B. Use established guidelines and evidence based resources for the management of acute asthma in the emergency department.
This will include current Australian asthma management guidelines, MEDLINE and Cochrane databases, existing hospital based forms and clinical pathways. Topics include;

• Asthma assessment in the emergency department
• Management of severe acute asthma
• Use of oral and or inhaled corticosteroids
• Use of asthma management plans
• Role of smoking cessation in asthma management
• Role of anticholinergics in asthma management
• Appropriate follow up care from the emergency department

C. Development of standard clinical forms that allows capture of key clinical fields onto a secure database in ED

• Clinical history and examination
• Asthma severity assessment
• Treatment order forms
• Progress and consultation form
• Vital sign observation chart
• Clinical decision support for asthma severity grading, management pathways, predicted peak expiratory flow rates based on age and gender
• Standardised discharge requirements
• Discharge summaries
• Asthma patient self education sheet
• Smoking cessation advice
• Asthma management plans.

D. Conduct pre implementation audit and chart review of asthma management performance indicators.

Within a six month audit period, data will be collected by retrospective chart review with no clinician or patient involvement in the data collecting process. Patients will be identified through existing EDIS patient tracking database.
Inclusion criteria for chart review are

1. any patient overe age 16 years
2. presents to the emergency department with a primary diagnosis of asthma or acute asthma.
3. First onset of wheeze unexplained by respiratory tract infection or allergic reaction.

Exclusion criteria are patients who reside in an aged care facility or have a history of cognitive impairment requiring long term additional supports at home.
The following data will be collected for all patients with a diagnosis of asthma who are admitted or discharged form the ED:

Asthma management performance indicators
Documentation

• Asthma severity grading
• Peak flow or spirometry recordings

Decision

• Admission rate by asthma severity
• Rate of chest imaging by asthma severity
• Use of oral corticosteroids upon discharge

Discharge plans

• Documented asthma management plan
• Documented smoking cessation
• Documented general practitioner follow up

Data will be stored in a secure password enabled file to ensure confidentiality and no identifying details will be used for data storage.

 Phase 2 – Implementation
Integrate electronic interface with existing ED information systems

1. testing and system checks to ensure data security and compatibility
2. laboratory and radiology reports to be directed onto the interface
3. Education of nursing and medical staff on system operation
4. Back up systems checked
5. Trial run before system goes online
   

 Phase 3 – Post Implementation Audit
Demonstrate and maintain performance improvements

• Chart review method will be used to audit the above asthma management performance indicators. Data will be collected from eligible medical records for a six month period.
• Review of system performance and feedback to ED
• Collection and statistical analysis of data
• Presentation of findings
• Maintain infrastructure