Background The National Review of Asthma Deaths (NRAD) made multiple recommendations in the form of quality indicators linked to improving care of asthma patients in light of a review of all asthma deaths.1 We undertook an audit to establish the degree to which a busy Emergency Department in inner London adheres to these.
Method Patients admitted in the month of June 2015 with an asthma related admission were identified via the coding department. This list was reviewed to include those patients confirmed to have an acute asthma admission and seen and discharged directly from the ED department (including the short stay ED ward). The electronic records of those included were reviewed using a data collection form relating to the NRAD quality indicators.
Results A total of 42 patients were included. Our findings included the following: 83% had mild or moderate severity, the remainder having acute-severe. Almost one third of patients did not have their peak flow documented on arrival, 76% did not have their usual best or predicted best documented and 66% did not have a discharge peak flow documented. There was no documentation if any patient had been provided with a personal asthma action plan (PAAP). Checking of inhaler technique was only documented for 14% of patients. One third of patients were presenting for the 2nd or more time with acute asthma. Finally only 3 patients had a recommendation for GP follow up but no timeframe was suggested.
Discussion Simple measurements and interventions were omitted in a significant number of patients, highlighting the need for improvement. Some of these were straightforward such as more meticulous recording of peak flow. Others may have reflected lack of competency in the healthcare professional e.g. inhaler technique training and PAAP. The development of an asthma care pathway that captures the essence of the NRAD quality indicators, together with staff training, is urgently required to ensure that EDs lead the way in reducing the morbidity and mortality associated with acute asthma presentations.
Funding Sponsorship for the audit was provided by Novartis.
Royal College of Physicians. Why Asthma still kills, The National review of asthma deaths. Confidential enquiry report, 2014.