P40 Care for patients attending emergency departments in england with an acute asthma exacerbation: how well do we meet suggested british thoracic society standards?

Introduction The UK National Review of Asthma Deaths (NRAD) found that 21% of patients had attended an emergency department (ED) due to asthma at least once in the year before their death. National guidelines have set out a series of recommendations to improve outcomes following admission with an asthma exacerbation. The following five elements of care now form the basis of the British Thoracic Society (BTS) Asthma Care Bundle: (1) inhaler technique assessment; (2) medication review; (3) written action plan; (4) consideration of trigger factors; and (5) arrangement of follow-up (within two working days in the community and two weeks with a specialist). Three NHS hospital trusts present baseline (interim) data, both as an assessment against the current care bundle elements and to allow the trusts to undertake a targeted approach of addressing internal processes to improve patient outcomes. Methods Setting: Three NHS hospital trusts in England over a six-month period. Design: A retrospective review of asthma care and subsequent discharge follow-up arrangements for patients attending ED with an asthma exacerbation. Participants were identified using electronic systems and eligibility confirmed by case note review. Data collection: Patient demographics and clinical measurements were recorded according to local requirements/protocols. Data analysis: Descriptive interim data are presented to date. Results The review included 319 eligible patients/admission events. Participant demographics and data on the asthma care received in the ED are summarised in table 1. Interim data from all three trusts showed only 46 (14.4%) records of inhaler technique assessment, the existence/provision of 36 (15.7%) personalised asthma action plans and 103 (32.3%) recorded instances of follow-up with the General Practitioner (GP) being arranged/recommended. No discharge follow-up GP events were recorded. Conclusion Four years after NRAD, it appears that their recommendations and elements of the relevant BTS Care Bundle seems to only be undertaken in a small proportion of patients attending ED with asthma exacerbation. It is likely that a range of barriers exist preventing guideline and care bundle implementation in this setting. This highlights the need for asthma services to work with EDs, acute and primary care colleagues/providers to develop flexible and scalable solutions.