HOSPITAL TREATMENT FOR CHILDREN EXPERIENCING SEVERE ASTHMA ATTACKS IS ‘VERY EFFECTIVE’ - BUT BETTER EDUCATION AND REVIEW IS NEEDED ON DISCHARGE TO REDUCE RE-ADMISSION – NEW AUDIT
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 from hospital, to help prevent future attacks and readmission to hospital - according to a new national audit published today (Tuesday 29 November 2016) by the British Thoracic Society (BTS).
The BTS National Paediatric Asthma Audit reviewed over 5,500 sets of data in 153 hospitals and healthcare settings across the UK in November 2015, probing the quality of emergency care and outcomes for children (over the age of one) admitted to hospital with severe asthma attacks.
Positive areas highlighted in the audit include the following:
- Medical care of children with acute wheezing and asthma continues to be highly efficient and effective.
- Most children receive appropriate ‘first line’ rescue treatment and care.
- Hospital stays are short – more than seven in ten children were in hospital for one day or less - with a substantial proportion receiving care entirely within the emergency department.
- Second line treatment used for children with more severe attacks such as intravenous therapies or ventilation, and the use of the paediatric intensive care unit, were only required in a very small proportion of children.
Key areas of concern highlighted in the audit include the following:
- Exposure to environmental tobacco smoke (ETS) was reported in nearly a third (32%) of children. The audit authors believe this level is worrying as tobacco smoke is known to be a key trigger for asthma attacks that require hospital admission. A significant proportion of hospitals did not provide data on this question, suggesting that clinical teams may need to pay greater attention to asking about exposure to tobacco smoke.
The authors point to the need for healthcare professionals to always discuss the issue of environmental tobacco smoke with parents or carers and, where appropriate, provide education about the role of tobacco smoke in worsening asthma, and the pivotal need to minimise exposure in children. Smoking cessation support should also 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. Furthermore, only four in ten (42%) of children were reported to have had their asthma inhaler technique assessed. The provision of, and adherence to, action plans has been shown to improve an individual’s control of their asthma and reduce the number of ‘attacks’ needing admission to hospital. Experts believe inadequate discharge procedures could be contributing to the current hospital re-admission rate of 15%.
- Contrary to national guidance, only 24% of families/carers and their children were advised to visit their GP within two working days after discharge from hospital.
Commenting on the report, Dr James Paton, Reader in Paediatric Respiratory Medicine, University of Glasgow, who led the Audit, said:
“The good news is that first line rescue care and treatment for children suffering from acute wheezing and asthma is generally working extremely well in hospitals. This is very welcome.
"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. This all points to good practice and adherence to national guidance.
“However, there are some ‘red flags’ highlighted in the report. It’s very worrying that a third of children were potentially exposed to tobacco smoke at home, although more data is needed here. When discharging children, health professionals should take the opportunity to talk about the issue with their parents or carers - and offer smoking cessation support as appropriate.
“Above all, it is paramount that children, families and carers leave hospital with a personal asthma action plan that provides guidance and practical tools on managing and monitoring asthma effectively. For many people, asthma is a long-term condition and should be treated as such. Provision of a proper long-term action plan at the hospital discharge stage can help prevent further ‘attacks’ and readmission in the future.
At present this isn’t happening in the majority of cases. We should be doing better.”
For more information or to arrange an interview, please contact Rosie Strachan:
020 7 831 8778
email@example.com (07970 118091)
Notes to editors:
The BTS National Paediatric Asthma Audit first took place in November 1998. It used a simple dataset based on the Scottish Intercollegiate Guidelines Network (SIGN)/BTS guidelines for the management of acute asthma in children and collected information in four key areas: patient demographics including age, sex and length of stay; initial assessment of asthma severity; in-hospital treatment; discharge planning – asthma treatment (if any) at discharge, asthma education and emergency planning, and follow-up arrangements. The audit is included on the list of National Audits for inclusion in the Department of Health Quality Accounts in England.
The British Thoracic Society (BTS) is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has over 3,000 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest. For more information, visit www.brit-thoracic.org.uk