Abstract
An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented—a National Asthma Audit; however, this hasn’t reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016. This was funded as a Local Incentive Scheme (LIS) aimed at improving quality health care delivery. Two years after the publication of the NRAD report it is surprising that risks for future attacks were not recognized, that few patients were assessed objectively during attacks and only 10% of attacks were followed up within 2 days. However, it is encouraging that CYP hospital admissions following the audit were reduced by 16%, with clear benefit for patients, their families and the local health economy. This audit has provided an example of how clinicians can focus learning on patients who have had asthma attacks and utilize these events as a catalyst for active reflection in particular on modifiable risk factors. Through identification of these risks and active optimization of management, preventable asthma attacks could become ‘never events’.
Highlights
The United Kingdom (UK) National Review of Asthma Deaths (NRAD)[1,2] demonstrated major deficiencies in the management of asthma in the UK
An asthma attack or exacerbation is a signal that treatment has failed, and we assumed that, as in the case of asthma deaths in the UK1 asthma attacks are potentially preventable
Following the NRAD, which was led by the first author of this paper, we decided, in Harrow, to try and identify ways in which we could reduce the incidence of asthma attacks focused on designing a clinical audit of management before and admissions to hospital for children and young during and after asthma attacks in children and young people (CYP)
Summary
The United Kingdom (UK) National Review of Asthma Deaths (NRAD)[1,2] demonstrated major deficiencies in the management of asthma in the UK. Each practice in Harrow has on average 4 and 10 acute admissions per year for asthma for children and young people (CYP) and all ages respectively using the ICD-10 coded data; the figures are 14 and 28 respectively using HRG coding for purposes of payments, all via the SUS data.[6] Accident and Emergency attendances are broadly coded, for example, all respiratory consultations have one single code and unreliable for specific disease care planning; Urgent Care Centres (UCCs) caring for patients out of hours use variable codes (mainly symptoms or process) for their attendances for asthma exacerbations. Specific recommendations were generated for Harrow practices, which are detailed in Table 2: Data derived by the Harrow CCG using ICD-10 coded discharge data form NHS England:[6] Harrow CCG practices achieved a 16% reduction of asthma admissions for 0–18 year olds from 189.4 per 100,000 in 2015–2016, to 159.2 per 100000 in 2016–2017. Istics and stimulate changes in clinical management of asthma in CYP aged under 19 years to include a follow up audit
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