An audit of the management of asthma patients in an accident & emergency department.

Abstract

To assess how the management of asthma in an Accident and Emergency Department (A&E) complies with the Guidelines of The British Thoracic Society and to assess the extent of involvement of the General Practitioner in the management of acute exacerbations of asthma in the community. A retrospective audit of asthma presentations to a North London Accident and Emergency Department during the period November 1999 to May 2000. 64 Casualty Cards were analysed. The frequency with which each of 8 clinical features indicating asthma severity was recorded ranged from 37% to 98%. Expected peak flow was recorded in 50% of patients. Of the 57 patients discharged, 35 had undertaken a repeat peak flow, and in 31 cases the last recorded repeat peak flow was more than 60% of the patient's normal or expected level (60% being the threshold suggested by the BTS at which discharge from A&E might be considered if the patient is stable or improving). 13 patients were recorded as having seen their GP prior to presentation to A&E. 17 of the patients discharged were recorded as having been instructed to see their GP for follow up. Compliance with BTS Guidelines would be improved if a more detailed history was taken from patients and if greater emphasis was placed on the recording of pre and post nebulizer peak flow measurements. The role of the GP in asthma management might be promoted if patients discharged from A&E are more strongly urged to visit their Practice.