Audit of hospital treatment for children highlights red flags for primary care

Children admitted to hospital with severe asthma attacks generally receive ‘very effective and efficient’ treatment and care - but a greater level of asthma education and review is needed on discharge, to help prevent future attacks and readmission, finds a national audit published today by the British Thoracic Society (BTS).  The report can be downloaded HERE 

The report says first line rescue care and treatment for children suffering from acute wheezing and asthma is generally working extremely well in hospitals.  Overall, children are receiving the right treatments, and admission to paediatric intensive care is only needed in a very small proportion of cases.  Hospital stays are generally very short with a substantial number of children receiving care entirely within the emergency department.   

However there are areas of concern for primary care highlighted by the audit.

These include: 

• Exposure to environmental smoke was reported in nearly a third (32%) of children. Tobacco smoke is known to be a key trigger for asthma attacks that require hospital admission and the report recommends that healthcare professionals always discuss the issue of environmental smoke with parents or carers. Smoking cessation support should be given as appropriate.
• Chest X-rays and antibiotics were used more frequently than evidence suggests is appropriate.
• Most aspects of discharge from hospital are less than optimal with fewer than six in ten (56%) children and families/carers being given a personal asthma action plan. Only four in ten (42%) children had their asthma inhaler technique assessed. The authors say inadequate discharge procedures could be contributing to the current hospital re-admission rate of 15%.
• Only 24% of families/carers and their children were advised to visit their GP within two working days after discharge from hospital.

ACTION for practices:

• Does your practice have a system to trigger a review when notified about a child’s asthma episode that was treated in hospital?
• A follow up appointment in the practice should include:
  • ensuring a personalised action plan is given to the child
  • identification of tobacco dependence in the child or their family and a treatment plan for those who are ready to quit
• Check that the basis for the diagnosis of asthma recorded in the notes was sound, particularly if the diagnosis was made for the first time at this admission.

ACTION for CCGS:

Contracts should be amended to ensure good practice recommended by the audit is achieved.

• In 44% of cases, no record of tobacco exposure was made during admission. Contracts should ensure that exposure by children to cigarette smoking is recorded in the recommended target of 80% of cases within two years.
• Contracts should instruct hospitals that on transferring care back to the GP the primary care review should occur within two days of discharge.
• Contracts should ensure that transfer of care from hospital is improved. 15% of children were readmitted within the 2 months following the first admission but more than two thirds (66%) were going home with no follow up plans.  If GPs and hospitalists improve their communication the number of children readmitted with further episodes of wheezing/asthma, particularly those with more than one admission, might be reduced.

The report can be downloaded HERE 

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