Asthma Medication Alert Improves Emergency Department Prescription Rates

Investigators assessed the effect of an electronic alert on the prescription rate of inhaled corticosteroids by healthcare providers in emergency departments for pediatric patients with poorly controlled persistent asthma.

An electronic alert within the emergency department (ED) workflow has demonstrated efficacy in initiating asthma controller medication among pediatric patients with poor disease control, according to study results recently published in Journal of Asthma.

This prospective study included 62 individuals treated at the Phoenix Children’s Hospital ED between February 9, 2018 and December 4, 2018, all of whom triggered an electronic alert for asthma controller medication. Upon reaching the participant, the medical provider either prescribed inhaled corticosteroids (ICSs) or reported a reason not to do so. All participants were ages 4 to 18 years and had visited the ED ≥2 times within the past year for asthma exacerbation. No participants had developmental delay, bronchopulmonary dysplasia, or an active prescription for ICSs within the past 3 months. Physicians, residents, and nurse practitioners received training on the alert through multiple educational sessions and by email. The Fisher exact test was used to compare postalert and pre-alert prescription rates, which had been published previously by the study researchers.

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Among study participants, 48 (77%; 95% CI, 65%-87%) received a prescription for ICSs compared with 0% (95% CI, 0%-7%) among 54 participants in a previous study, representing a markedly improved rate of prescription with the alert. Participants discharged without a prescription did not differ significantly in baseline characteristics from participants with a prescription, and no reason was indicated as to why no prescription was applied.

Limitations to this study included an inability to examine individuals for whom ICSs were justifiably not prescribed, the inclusion of infrequent ED visitors who may not have been given sufficient instruction on the alert, and nurses and residents not receiving the same financial incentive as physicians.

Study researchers concluded that “clinical decision support in the ED is effective to initiate asthma controller medication in an acute care setting. Specifically, an electronic alert inserted into the ED workflow to populate a discharge order set including asthma controller medication, combined with a financial incentive to ED physicians, is a strategy that can be implemented in general EDs to improve asthma controller prescription rates.”


Farmer A, Mirea L, Carter J, et al. Inhaled corticosteroids prescriptions increased in the ED for recurrent asthma exacerbations by automated electronic reminders in the EDJ Asthma. 2019:1-5.