Background In 2010/11 NHS Wakefield District had the highest rate of admissions for acute exacerbation, in adults, within Yorkshire and Humber. The 2009 BTS adult asthma audit highlighted readmission rates within one month to be 19% compared to the national average of 8%. Furthermore, the same audit demonstrated that Pinderfields and Pontefract hospitals (part of Mid Yorkshire NHS Trust) were markedly underperforming, compared to national average, in terms of asthma review, patient education and follow up according to BTS/SIGN guidance.
Aims and objectives As part of a new asthma service we introduced an adult acute asthma ‘care bundle’ to improve the frequency of asthma review, patient education and improve post admission follow up. We also aimed to reduce 28 day readmission rates by 20% compared to 2010/11.
Methods In February 2011 Pinderfields General Hospital merged its acute inpatient medical services with Pontefract General Infirmary enabling a restructuring of the respiratory team and creation of a Mid Yorskhire Asthma service. Following a programme of staff education the acute asthma care bundle was introduced for all adult patients attending the Emergency Department and Acute Medical Unit with an exacerbation of asthma. Data were collected prospectively following the introduction of the care bundle and is compared against the 2009 BTS audit data. Data presented is from the first 46 patients.
Outcomes Following the introduction of the care bundle, inhaler technique assessment was performed in 75.6% of patients, compared to 38% previously. Asthma reviews (including self management plan and asthma education) were performed in 88.9% of patients, compared to 16% previously. Patients were recommended primary care follow up and had arranged secondary care follow up in 80 and 93.3% of admissions, compared to 19 and 37% previously. Furthermore, compared to 2010/11 there was a 66% reduction in 28 day readmissions, mean monthly average reduced from 5.0 to 1.67.
Conclusion As part of a restructured respiratory and asthma service the introduction of an acute asthma care bundle led to marked improvements of patient management and 28 day readmission rates.