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M6 Improving follow-up in patients attending and discharged from accident and emergency with asthma exacerbations
  1. WJ Newman,
  2. O Lamont
  1. Forth Valley Health Board, Larbert, UK

Abstract

Introduction The Respiratory and Accident and Emergency (A&E) departments in Forth Valley audited asthma care in the emergency department over the past years. Shortcomings in a number of areas have been identified and quality improvement measures undertaken.

One area was the failure to organise follow-up for patients following attendance at A&E, (24% in 2009, 47% in 2012). As a result a new system was introduced.

Methods Forth Valley Health Board serves a population of 310,000 and has one acute hospital with 860 beds. The Respiratory Service comprises of 6 Consultants and 5.5 Respiratory Nurses. There are specialist asthma clinics run by the physicians/nurses. Patients with an asthma exacerbation discharged from the A&E department are identified by interrogating the A&E patient management system daily and clinical and contact details obtained. The Respiratory nurses contact any patient to obtain further information (standardised questionnaire) and make a management plan with the patient. Their case is then discussed with the on-call Respiratory physician and further recommendations instituted.

Results 88 cases ( 27 (30%) male, 61 (70%) female) were identified as having attended with an exacerbation of their asthma and discharged from A&E during 2015. Median age 36 (range 17–78), 46 (58%) presented at weekends or outwith working hours (0800–1800), 70 (80%) were discharged home with oral steroids.

Of the 88 patients one had no telephone/one lived outside the UK. 26 (30%) patients did not reply and the GP practice was contacted to advise of the attendance. Following discussion with the consultant it was recommended that 11 (42%) continued to be managed in primary care (follow-up attendance unknown), and 15 (58%) be reviewed by the Respiratory Service. 13 (86%) attended the appointment.

62 (70%) were contactable, one was a nursing home resident (Respiratory nurses subsequently visited), one declined to answer questions. 35 (39%) had already made an appointment to see their general practitioner. Following discussion one patient was re-admitted (same day), 30 (48%) patients continued to be managed in primary care (follow-up attendance unknown) and 31 (50%) were reviewed by the Respiratory service. 27 (87%) attended the appointment.

Conclusions The introduction of a telephone conversation/management plan improves follow-up of patients with asthma exacerbations discharged from A&E.

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