RESUMEN
OBJECTIVE: The purpose of this study was to analyze the impact of a quality assurance program intended to improve the care of children with acute asthma in the emergency ward of a first level hospital. PATIENTS AND METHODS: New guidelines for acute asthma management in children were developed and applied beginning 1-1-1997. The ways to deal with an asthma crisis in 1996 and 1997 were compared. The quality guarantee cycle was the method for application of the guidelines, health workers being aware of the starting point (1996) and which areas could be improved. The quality of the clinical assessment of the asthma crisis, the adequacy of treatment, and the final destination of the patients (discharge or admission) were evaluated. RESULTS: Seventy-seven and 68 asthma crises were attended to during 1996 and 1997, respectively. We noticed significant improvements in the clinical assessment of the crisis (p < 0.001), in the correct usage of the term "asthma crisis" (p < 0.001) and in the description of the crisis severity (p < 0.001). The number of improper therapeutic procedures was reduced (p < 0.0001). Children with a mild crisis, except for those associated with risk factors (14% in 1996 and 6% in 1997), were discharged from the hospital. All children with severe crises were admitted to the hospital. Of the children with moderate crises, 75% need hospitalization in 1996, while only 45.1% did during 1997 (p = 0.05). CONCLUSIONS: Following appropriate guidelines during acute asthma attacks implies better care of the asthmatic child and reduces the number of hospital admissions. The quality guarantee cycle is a proper way to achieve these goals.