Inpatient Electronic-Consults for Asthma Hospitalization Improve Outpatient Outcomes.

Objective: Asthma exacerbations frequently lead to systemic corticosteroid use, emergency department (ED) visits, and hospitalizations. While specialist care can improve asthma outcomes, a critical gap often exists between inpatient hospitalization and outpatient follow-up. This study measured the clinical impact of an allergy/immunology (A/I) electronic consult (e-consult) for patients hospitalized for asthma exacerbation.

Methods: In this quality improvement project, all patients admitted for asthma received an A/I e-consult addressing asthma controller therapy and outpatient follow-up. Clinical outcomes were tracked for the subsequent year. Results are reported with descriptive statistics, and a paired T-test was used to compare groups.

Results: 133 patients were enrolled; mean age 28.9 ± 23.3 years, 76 (57%) females, 64 (48%) Black, and 36 (27%) Hispanic. 73 (55%) patients were on asthma maintenance therapy, whereas 60 (45%) were on monotherapy with a short-acting beta agonist (SABA). In the year prior to hospital admission, 43 (32%) had been seen in the ED/UC and 73 (55%) had been previously hospitalized. The mean courses of SCS was 2.5 ± 2.2. Following the inpatient e-consult, 77 (58%) followed up as scheduled, and there was a decrease in hospitalization (mean 1.38 ± 0.11 to 0.42 ± 0.10, p<.0001), ED/UC visits (mean 1.35 ± 0.23 to 0.70 ± 0.15, p=.0025), and SCS courses (mean 2.74 ± 0.25 to 1.43 ± 0.25, p<.0001). An inpatient e-consult improved outcomes regardless of follow-up status for both pediatric and adult patients.

Conclusion: Inpatient A/I e-consults for asthma exacerbations decreased SCS use and healthcare utilization, including inpatient hospitalization, in both pediatric and adult patients.