Improving the follow-up of patients with exacerbations of asthma after discharge from the emergency department.
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Authors
Carling, Michael
Green, Nicola
Ireland, Peter
Issue Date
2021
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Abstract
"Introduction and Objectives: We sought to improve the care of patients who presented with asthma exacerbations based on recommendations from the National Review of Asthma Deaths (NRAD) and the British Thoracic Society (BTS) asthma bundle.
Methods: We developed a specialist nurse-led service to follow-up patients with exacerbations of asthma within 48 hours of discharge from the emergency department (ED). We also digitalised the asthma proforma used for assessment of patients by the respiratory specialist nurse team.
We evaluated these changes by collecting data on the proformas and discharge letters completed during follow-up and compared them with the results of an ED audit to determine whether the appointments were better addressing the BTS recommendations. We also compared the updated proformas with previous proformas and recorded the information subsequently relayed to primary care.
Results: We identified 63 patients who were referred for outpatient follow-up between January – June 2019, which 55/63 (87%) attended. There was a statistically significant increase in the number of patients having the BTS recommendations addressed compared to the 2015 ED audit where comparable data was available (Table 1).
Comparison of the old assessment proformas with their subsequent discharge letters showed that salient information was often not relayed to primary care e.g. smoking status confirmed in 100% of proformas but only available in 4.2% of discharge letters. Initial testing of the digitalised proformas showed that more recommendations were addressed and relayed to primary care.
Conclusion: Specialist nurse-led asthma follow-up appointments have improved the quality of care we provide to our asthma patients. Both the number of patients who receive follow-up after an asthma exacerbation and the quality of their assessment have improved in line with BTS recommendations. We hope that ongoing work on the assessment proformas will further increase our adherence to these recommendations and improve communication with primary care."
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Citation
Ireland, P., Carling, M. and Green, N. (2021) P145?Improving the follow-up of patients with exacerbations of asthma after discharge from the emergency department. Thorax; 76 : A166-A167.
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Thorax
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1468-3296