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Economics and the burden of respiratory disease
S7 Annual trends in asthma emergency attendance, hospital admission and readmission
  1. V Kuan,
  2. S J Quantrill
  1. Department of Respiratory Medicine, Whipps Cross University Hospital, London, UK

Abstract

Introduction and Objectives Recent government initiatives rooting care of chronic conditions in primary care settings with particular emphasis on reducing hospital use require on-going collection of high-quality data. However, in most Trusts this data are not systematically reported. Data around readmissions have recently become a priority issue with proposals to penalise secondary care Trusts with high readmission rates.

Methods Asthma emergency attendances and reattendances to our Trust from 2003/4 to 2009/10 and hospital admissions and readmissions from 2001/2 to 2009/10 were obtained from Symphony and Patient Administration System (PAS). For hospital admissions discharge coding was used to identify cases.

Results 8155 emergency attendances were recorded over the 7 year period between 2003/4 and 2009/10, of which 4691 were adult (≥18 years) and 3464 children (<18 years). During this time, 2927 patients out of 4479 (65%) attended just once. Emergency attendances were stable for children ranging from 442 in 2003/4 to 455 in 2008/9, but rose sharply to 652 in 2009/10. Adult emergency attendances decreased from 666 in 2003/4 to 512 in 2008/9, but also rose sharply in 2009/10 to 790. Emergency adult reattendances for 0–28 days, 0–90 days and 0–365 days fell from 85, 128 and 227, respectively in 2003/4 to 38, 64 and 142 in 2008/9. From 2001/2 to 2009/10, there were 3707(2341 adult, 1366 children) hospital asthma admissions. Out of 1599 adult patients over this period, 1225 had just one admission. Admissions rose from 98 to 191 for children and 153 to 322 for adults from 2001/2 to 2009/10. Hospital adult readmissions have varied, ranging from 5(2001/2) to 16(2008/9) for 0–28 days, 14 (2003/4) to 35 (2005/6) for 0–90 days and 35 (2002/3) to 68 (2005/6) for 0–365 days. Mean length of stay fell from 5.80 days in 2001/2 to 3.88 days in 2009/10.

Conclusions Large numbers of patients attend our emergency department for acute asthma. Admissions for acute asthma have risen markedly, more than doubling over 9 years. Numbers of readmissions within 28 days are relatively small, but the readmission rate within one year is relatively high at 22.70% (2008/9). These figures have important implications for resource allocation and training across the primary/secondary care divide.

Abstract S7 Figure 1

Number of adult asthma admissions at Whipps Cross Hospital.

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