Management of asthma in patients discharged from A and E

Introduction: Northumbria has one of the highest rates of asthma prevalence and Au0026E attendance in England/Wales. The NRAD report highlighted common deficiencies in patient care. Patients discharged from Au0026E with asthma are a high risk group. Aim/Objectives: We wanted to see how well we complied with asthma guidelines/NRAD recommendations when treating patients who attended and were subsequently discharged from Au0026E. Methods: Au0026E notes and attendance records were prospectively audited on a daily basis for a 3 month period by a respiratory specialist nurse. Results: We identified 50 patients over a 3 month period. There was a significant difference between patients we prospectively identified and those coded as having attended with asthma. The Au0026E asthma care bundle was only used in 28% of patients. Patient care was improved with the bundle but not all components were completed. Discharge arrangements were often inadequate. Inhaler technique was checked in 20% of patients, a self management plan provided for 2/50 patients. Oral corticosteroids were prescribed for 62% of patients and Inhaled Corticosteroids 18%. Primary care was informed of the admission for 11/50 (22%) and of these only 2/50 were actually seen. No patients were referred to the respiratory team. Conclusion: There is a need to improve the care of this group of patients who are at increased risk of death and have significant morbidity. Despite an asthma bundle being available, the impact on patient care was minimised by low compliance. Novel IT based approaches may be helpful as an alternative. We have decided to incorporate training in asthma care into junior doctor foundation training in the trust to try and address the issue. Coding for asthma is often inaccurate.