LAUSR

Introduction We previously reported the outcome of a retrospective evaluation of asthma care for patients attending three emergency departments (ED) in England. 1 We demonstrated that components of the BTS Asthma Care Bundle were completed in less than a third of patients attending the ED with an acute exacerbation. We now report prospective data from two of the participating trusts following implementation of interventions designed to improve asthma care for patients attending the ED. Methods Setting: Two NHS hospital trusts in England over a six-month period. Design: Prospective evaluation of asthma care for patients attending the ED with asthma exacerbation. Intervention: Both trusts implemented electronic systems to identify asthma patients attending ED. All patients were contacted by an asthma nurse by telephone following their attendance. In Trust 1, contacted patients were invited to attend a specialist nurse-led clinic within 2 working days of ED attendance. In Trust 2, a specialist nurse-led telephone consultation was undertaken and patients were triaged for follow-up using a standard protocol. Data collection: A standard dataset was collected for each patient event, including demographics and delivery of asthma care with reference to the BTS asthma Care Bundle. Data analysis: Data are presented descriptively. Results This study includes 120 patient events (26% male, 17–81 years). Significant improvements in asthma care were observed in both trusts. Attendance in nurse-led clinics in Trust 1 led to completion of care elements set-out in the BTS asthma bundle in almost all patients. Follow-up arrangements improved in both Trusts. Data are presented in Table 1. Conclusion Electronic systems can be used to identify patients attending ED with asthma exacerbations for review by specialist asthma services. Elements of asthma care described in the BTS bundle are infrequently performed in the ED. Early specialist nurse-led clinic review can address this. Identifying patients and arranging review in specialist nurse-led clinics offer a way of providing optimal asthma care for patients discharged from ED.Abstract P159 Table 1 Descriptor Retrospective study1 Prospective study Trust 1 and 2 (n= 207) Trust 1 (n= 68) Trust 2 (n= 52) Combined (n= 120) Inhaler technique assessment, n (%)* - Yes- No- Not documented 6 (2.8)114 (55.1)87 (42.1) 67 (98.5)0 (0)1 (1.5) 3 (5.8)1 (1.9)48 (92.3) 70 (58.3)1 (0.8)49 (40.8) Medication adherence assessed, n (%) - Yes- No- Not recorded Trust 1 only 0 (0)0(0)117 (100) 56 (82.3)4 (5.9)8 (11.8) 43 (82.7)2 (3.8)7 (13.5) 99 (82.5)6 (5.0)15 (12.5) Asthma action plan provided, n (%) - Yes- No- Unknown 0 (0)117 (56.5)90 (43.5) 67 (98.5)0 (0)1 (1.5) 8 (17.3)21 (40.4)22 (42.3) 75 (63.3)21 (17.5)23 (19.2) Follow-up arranged, n (%) Community- Yes- No- Not recorded Specialist- Yes- No 36 (17.4)164 (79.2)7 (3.4)2 (1.0)205 (99.0) 0 (0)0 (0)68 (100) 68 (100)0 (0) 31 (59.6)9 (17.3)12 (23.1) 34 (65.3)18 (34.6) 31 (25.8)9 (7.5)80 (66.7) 102 (85)18 (15) Smoking status documented, n (%) - Yes- No- Current smoker Trust 1 Only 18 (15.4)99 (84.6) 6 (6) 63 (92.6)5 (7.4)18 (26.4) 38 (73.1)14 (26.9)9 (17.3) 101 (84.2)19 (15.8)27 (22.5) * All assessed in the ED in the retrospective study; Trust 1 completed assessment during the nurse-led clinic in the prospective study, whereas in Trust 2 this was still actioned in the ED