Emergency asthma care in England: Themes identified during audits at five hospital trusts

Introduction The National Review of Asthma Deaths in the UK identified acute asthma care as a potential area of improvement ( Why asthma still kills: the National Review of Asthma Deaths, 2014). Novartis offered English trusts with high rates of asthma admissions unrestricted financial support to audit asthma emergency care pathways. Methods Five hospital trusts developed an individual audit strategy tailored to the local asthma care pathway, focusing on patients presenting to emergency departments (EDs). Results The median rate of asthma emergency admissions per 100,000 population over age 19 years ( NHS Atlas of Variation in Healthcare , 2015) is significantly higher in the clinical commissioning groups (CCGs) served by these five trusts (115.4; range 75.8–218.3) compared with all other English CCGs (78.1; range 32.8–223.9). Combined, the five trusts reviewed 2,511 asthma-diagnosed ED attendances by approximately 2,117 adults. Although individual hospital trusts reported different local issues, common themes emerged. Asthma misdiagnosis or inaccurate coding in EDs can lead to mistreatment or overtreatment. Asthma care bundle adherence was higher on wards than in EDs. ED reattendance rates are an area for improvement; across the five trusts, 10.5–55.5% of patients had ≥2 ED attendances within 12 months. Patients who attend an ED are often not followed up in primary or secondary care, which is a probable cause of ED reattendance. Conclusion Although asthma care pathways differed between the audited trusts, common problems emerged. Respiratory services, EDs and primary care need to work more closely together to implement changes to service design that will improve outcomes for patients with asthma.