Emergency department (ED) attendance with asthma: An unmet need for specialist review

Abstract

Leeds is a large urban city served by 2 ED with an above average rate of asthma admissions. The aim of this study was to characterise the population with ED attendance not already known to specialist services. We retrospectively reviewed all patients attending the ED with a diagnosis of acute asthma between 01/01–31/03/2015. The shared health care record was reviewed to determine the frequency of oral corticosteroids, hospital attendance, asthma treatment stage and whether specialist review had occurred. During the study period 223 attendances were identified by 196 individuals. The majority of these attendances (80%), were self-referrals to the ED of whom the majority were subsequently discharged directly from the ED. Two thirds of the people had never received a specialist asthma assessment. During the study period 57 (29%) individuals, were identified as needing specialist review on the basis of being at step 3 or 4 of the BTS guidelines and/or multiple asthma ED attendance in the preceding 12 months. This study identified a population of people with significant evidence of poor asthma control, managed in primary care and using the ED for management of exacerbations. These exacerbations were not severe enough to warrant admission, with subsequent routine specialist review. Subsequently, we have implemented a systematic review of shared health care records for all ED asthma attendances, with communication to primary care advising asthma review +/- specialist referral on the basis of asthma step / exacerbation frequency. We would suggest close working with colleagues in the ED to ensure robust systems are in place to identify people with asthma at potential high risk of future exacerbations.