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Tentative criteria for hospital care of patients with asthma developed for Professional Standards Review Organizations (PSRO)
CORRESPONDENCE
Tentative criteria for hospital care of patients with asthma developed for Professional Standards Review Organizations (PSRO) To the Editor: The Task Force on Guidelines of Care of the AMA Advisory Committee on PSRO has asked specialty societies to publish criteria of care for the diseases t h a t make u p 7 5 per cent of their hospital admissions in their own specialty journals. The guidelines of care for asthma have been presented in a standardized outline form that has been developed by the Task Force and will be used b~; the other specialties when their criteria are published. The tentative guidelines t h a t are published below for care of the hospitalized asthmatic patient have been. developed by the Conjoint Soeio-Economic Committee for Allergy, and the final d r a f t was completed on J a n u a r y 19, 1974. Representatives from the American Academy of Allergy, the American College of Allergy, and the American Association for Clinical Immunology and Allergy worked out these criteria. These criteria are subject to change, and suggestions from all allergists are welcome. I t is possible these guidelines will be published at some future date in the Journal of the American Medical Association, and also a monograph containing all of the guidelines of care for the various specialties in medicine will eventually b e publistmd. Robert 8. Ellis, M.D., Oblahoma City, Obla. American Academy of Allergists' Representative to A M A Interspecialty Council Asthma--Criteria for hospital care 1. Indications for admission a. Severity of the asthmatic state not responding to conventional outpatient therapy b. Asthma complicated by major system diseases e. Complications of therapy d. Patients requiring preparation for surgery 2. Length of hospital stay a. Age through 15--up to 15 days b. Age over 15---up to 22 days 3. Essential services consistent with diagnosis a. ttistory: Cough, wheezing, shortness of breath b. Past history: Any prior allergic condition c. Physical examination: Wheezing-type respiration with increased rate d. Laboratory tests Usual Ocvasional Routine C.B.C. and blood chemistries Blood oxygen, carbon dioxide, and pI-I as performed on other patients adSinus x-ray mitted to medical and pediatric diSputum cytology (eosinophils, etc.) visions Sputum smear and culture for bacteria and Chest x-ray fungi Serum electrophoresis Immunoglobulin determinations including I g E (quantitative) Precipitin tests for allergic lung diseases Electrocardiogram e. Special diagnostic procedures Usual Occasional Spirometric pulmonary function tests Allergy skin tests Radioallergosorbent test VoL 5d~ No. 1, pp. 65-66
66
Correspondence
J, ALLERGYCLIN. IMMUNOL. JULY 1974
Skin test for fungal diseases Serum alpha-l-antitrypsm Skin test for tuberculin Sweat test for sodium X-ray laminogram of chest Bronchoscopy (see consultation below) Lung scan Serum complement levels 4. Consultations a. Other allergists when the severity of the case warrants b. Otolaryngologist for evaluation of sinuses, tonsils, adenoids, ears, nasal polyps, etc. c. Psychiatrist d. Bronchoseopist for diagnosis and treatment e. Other consultants as indicated 5. Special therapy services a. Inhalation therapy ( I P P B ) b. Volumetric ventilatory assistance c. B r e a t h i n g exercises and Other physical therapy d. Postural drainage e. Tracheobronchial lavage 6. Specific nursing services Self-care ambulatory, floor, special, or intensive care nursing as determined by the severity of the case 7. Medications a. Sympathieomimetie bronchodilators b. X a n t h i n e bronchodilators c. Expectorants d. Corticosteroids a n d / o r ACTH e. Infusion of fluids with or without added appropriate medications f. Antibiotics, oxygen, sodium bicarbonate, and other therapeutic agents as indicated 8, Operations a. Tracheostomy b. Bronchoscopy ~see above) 9. Hospital course a. Uncomplicated--uneventful recovery from admitting condition b. Complicated (1) Refractory condition (2) Carbon dioxide narcosis a n d / o r hypoxia (3) Pulmonary infection, including pneumonia (4) Associated pulmonary emphysema or bronchiectasis (5) Pneumothorax (6) Congestive heart failure (7) Complications resulting from corticosteroid therapy (8) Complications of ventilatory therapy (9) Phlebitis resulting f r o m venipuncture and infusions (10) Reactions to medications (11 ) Other complications c. Any newly diagnosed condition during hospitalization 10. Indications for discharge: Relief or control of the asthmatic state for at least 24 hours a f t e r discontinuance o f parenteral therapy 11. Follow-up care : As condition indicates
Conjo~t 8oeio-eeonom~e Comm~ee .for Allergy
Tentative criteria for hospital care of patients with asthma developed for Professional Standards Review Organizations (PSRO) To the Editor: The Task Force on Guidelines of Care of the AMA Advisory Committee on PSRO has asked specialty societies to publish criteria of care for the diseases t h a t make u p 7 5 per cent of their hospital admissions in their own specialty journals. The guidelines of care for asthma have been presented in a standardized outline form that has been developed by the Task Force and will be used b~; the other specialties when their criteria are published. The tentative guidelines t h a t are published below for care of the hospitalized asthmatic patient have been. developed by the Conjoint Soeio-Economic Committee for Allergy, and the final d r a f t was completed on J a n u a r y 19, 1974. Representatives from the American Academy of Allergy, the American College of Allergy, and the American Association for Clinical Immunology and Allergy worked out these criteria. These criteria are subject to change, and suggestions from all allergists are welcome. I t is possible these guidelines will be published at some future date in the Journal of the American Medical Association, and also a monograph containing all of the guidelines of care for the various specialties in medicine will eventually b e publistmd. Robert 8. Ellis, M.D., Oblahoma City, Obla. American Academy of Allergists' Representative to A M A Interspecialty Council Asthma--Criteria for hospital care 1. Indications for admission a. Severity of the asthmatic state not responding to conventional outpatient therapy b. Asthma complicated by major system diseases e. Complications of therapy d. Patients requiring preparation for surgery 2. Length of hospital stay a. Age through 15--up to 15 days b. Age over 15---up to 22 days 3. Essential services consistent with diagnosis a. ttistory: Cough, wheezing, shortness of breath b. Past history: Any prior allergic condition c. Physical examination: Wheezing-type respiration with increased rate d. Laboratory tests Usual Ocvasional Routine C.B.C. and blood chemistries Blood oxygen, carbon dioxide, and pI-I as performed on other patients adSinus x-ray mitted to medical and pediatric diSputum cytology (eosinophils, etc.) visions Sputum smear and culture for bacteria and Chest x-ray fungi Serum electrophoresis Immunoglobulin determinations including I g E (quantitative) Precipitin tests for allergic lung diseases Electrocardiogram e. Special diagnostic procedures Usual Occasional Spirometric pulmonary function tests Allergy skin tests Radioallergosorbent test VoL 5d~ No. 1, pp. 65-66
66
Correspondence
J, ALLERGYCLIN. IMMUNOL. JULY 1974
Skin test for fungal diseases Serum alpha-l-antitrypsm Skin test for tuberculin Sweat test for sodium X-ray laminogram of chest Bronchoscopy (see consultation below) Lung scan Serum complement levels 4. Consultations a. Other allergists when the severity of the case warrants b. Otolaryngologist for evaluation of sinuses, tonsils, adenoids, ears, nasal polyps, etc. c. Psychiatrist d. Bronchoseopist for diagnosis and treatment e. Other consultants as indicated 5. Special therapy services a. Inhalation therapy ( I P P B ) b. Volumetric ventilatory assistance c. B r e a t h i n g exercises and Other physical therapy d. Postural drainage e. Tracheobronchial lavage 6. Specific nursing services Self-care ambulatory, floor, special, or intensive care nursing as determined by the severity of the case 7. Medications a. Sympathieomimetie bronchodilators b. X a n t h i n e bronchodilators c. Expectorants d. Corticosteroids a n d / o r ACTH e. Infusion of fluids with or without added appropriate medications f. Antibiotics, oxygen, sodium bicarbonate, and other therapeutic agents as indicated 8, Operations a. Tracheostomy b. Bronchoscopy ~see above) 9. Hospital course a. Uncomplicated--uneventful recovery from admitting condition b. Complicated (1) Refractory condition (2) Carbon dioxide narcosis a n d / o r hypoxia (3) Pulmonary infection, including pneumonia (4) Associated pulmonary emphysema or bronchiectasis (5) Pneumothorax (6) Congestive heart failure (7) Complications resulting from corticosteroid therapy (8) Complications of ventilatory therapy (9) Phlebitis resulting f r o m venipuncture and infusions (10) Reactions to medications (11 ) Other complications c. Any newly diagnosed condition during hospitalization 10. Indications for discharge: Relief or control of the asthmatic state for at least 24 hours a f t e r discontinuance o f parenteral therapy 11. Follow-up care : As condition indicates
Conjo~t 8oeio-eeonom~e Comm~ee .for Allergy