G217(P) Improving paediatric asthma long-term management through the emergency department

Aims The UK has one of the worst paediatric asthma mortality rates in Europe. The National Review of Asthma Deaths found that we could prevent many deaths with better basic asthma care and long-term management. We aimed to improve the assessment of children with asthma in the Emergency Department (ED), and their long-term management. Methods We collected data over three months on those >5 presenting to ED with asthma. We subsequently introduced an ED assessment proforma for these children. We re-audited over the same time period the following year and we have made changes to the proforma based on these results, which we will continue to re-assess, and further improve. Results Between 2017 and 2018 we saw a 60% increase in numbers of children attending ED with asthma. We were initially poor at recording patient/carer smoking status with this being done in 23% of patients. Following proforma introduction, this increased to 51%. The objective assessment of chronic severity of asthma also improved, from 67% having this documented in 2017 to 99% in 2018. However, we remained poor at documenting assessment of inhaler technique, recording this in only 23% of patients in 2017 and 13% in 2018. Documentation of follow up plans was also poor and did not improve with proforma introduction. We also saw significant changes in practice; new preventer therapies were introduced in 2% of patients in 2017, but 14% in 2018. Conclusion We found that by designing a proforma with specific prompts we could affect what questions people asked, long-term management and documentation. This worked well for prompts we included such as smoking status and objective assessment of severity, though it did not work for other key points. We have now re-designed the proforma which is rolling out alongside education sessions. This includes a revised discharge checklist highlighting key care standards. We have included information to signpost parents/carers to smoking cessation services and flowcharts to ensure correct follow up is arranged. We have attempted to shift the approach of clinicians from treating just an exacerbation, to thinking about treating asthma as a chronic condition.