Introduction Suboptimal discharge management of asthmatic patients increases risk of early re-hospitalisation leading to avoidable burden on healthcare services. Previous BTS asthma audits have demonstrated that discharge planning was an area for improvement. In Sept 2011 we developed an asthma Inreach team (2 band 6 nurses, 1.3 whole time equivalents) to improve asthma inpatient care. In Oct 2012 this service was expanded to actively trace all patients who had attended the Emergency Department (ED) in the previous 24hrs and arrange follow up in an asthma nurse specialist clinic (ANS) within one week. We evaluated the impact of this service.
Methods Data was extracted from clinic letters. The asthma Inreach team reviewed patients admitted to the respiratory wards and a proforma was used to document interventions.
Results ED: Between Oct 2012 to May 2013, there were 215 patients with 245 attendances to ED. 12 patients were readmitted within 30days. Only 26 (12%) patients were known to chest clinic. 138 (64%) attended follow up in the ANS clinic. 70 (51%) had poor compliance issues addressed. 48 (22%) had a significant change in treatment and 30 (14%) were referred onto the difficult asthma clinic. All received written asthma management plans (WAMP). Asthma Inreach: Between Sept 2011 to May 2013, the asthma inreach team undertook 240 reviews on 213 patients. 142 (68%) patients given WAMP 91 (43%) inhaler technique initially poor improved with education. 65 (27%) had poor compliance. 155 (73%) patients were subsequently followed up in ANS clinic. 30 day readmission rate decreased from 2.7% in 2011/12 to 1.9% in 2012/13.
Conclusion This study demonstrates that the introduction of an asthma inreach service & ANS clinic has significantly improved asthma management, follow up according to BTS guidelines and reduced 30 day readmissions. A significant number of patients had evidence of poor compliance, poor inhaler technique, lack of WAMP which was addressed by the asthma team. A number of patients were more complex and required review in the difficult asthma clinic.