Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1993 Aug;69(2):202–205. doi: 10.1136/adc.69.2.202

Audit strategies to reduce hospital admissions for acute asthma.

G J Connett 1, C Warde 1, E Wooler 1, W Lenney 1
PMCID: PMC1029457  PMID: 8215521

Abstract

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards filled in by parents indicated that children sent home without admission fared no worse at home than those admitted and then discharged for the two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more children to be safely managed in the community.

Full text

PDF
202

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. R. Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom. Thorax. 1989 Aug;44(8):614–619. doi: 10.1136/thx.44.8.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Asthma: a follow up statement from an international paediatric asthma consensus group. Arch Dis Child. 1992 Feb;67(2):240–248. doi: 10.1136/adc.67.2.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burney P. G., Chinn S., Rona R. J. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86. BMJ. 1990 May 19;300(6735):1306–1310. doi: 10.1136/bmj.300.6735.1306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burr M. L., Butland B. K., King S., Vaughan-Williams E. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child. 1989 Oct;64(10):1452–1456. doi: 10.1136/adc.64.10.1452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carlsen K. H., Orstavik I., Leegaard J., Høeg H. Respiratory virus infections and aeroallergens in acute bronchial asthma. Arch Dis Child. 1984 Apr;59(4):310–315. doi: 10.1136/adc.59.4.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Centor R. M., Yarbrough B., Wood J. P. Inability to predict relapse in acute asthma. N Engl J Med. 1984 Mar 1;310(9):577–580. doi: 10.1056/NEJM198403013100907. [DOI] [PubMed] [Google Scholar]
  7. Clark N. M., Feldman C. H., Evans D., Levison M. J., Wasilewski Y., Mellins R. B. The impact of health education on frequency and cost of health care use by low income children with asthma. J Allergy Clin Immunol. 1986 Jul;78(1 Pt 1):108–115. doi: 10.1016/0091-6749(86)90122-3. [DOI] [PubMed] [Google Scholar]
  8. Collet J. P., Ducruet T., Floret D., Cogan-Collet J., Honneger D., Boissel J. P. Daycare attendance and risk of first infectious disease. Eur J Pediatr. 1991 Jan;150(3):214–216. doi: 10.1007/BF01963570. [DOI] [PubMed] [Google Scholar]
  9. Crompton G. K., Grant I. W., Bloomfield P. Edinburgh Emergency Asthma Admission Service: report on 10 years' experience. Br Med J. 1979 Nov 10;2(6199):1199–1201. doi: 10.1136/bmj.2.6199.1199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dawson K. P. The severity of asthma in children admitted to hospital: a 20 year review. N Z Med J. 1987 Aug 26;100(830):520–521. [PubMed] [Google Scholar]
  11. Fischl M. A., Pitchenik A., Gardner L. B. An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. N Engl J Med. 1981 Oct 1;305(14):783–789. doi: 10.1056/NEJM198110013051402. [DOI] [PubMed] [Google Scholar]
  12. Fleming D. M., Crombie D. L. Prevalence of asthma and hay fever in England and Wales. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):279–283. doi: 10.1136/bmj.294.6567.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hill A. M. Trends in paediatric medical admissions. BMJ. 1989 Jun 3;298(6686):1479–1483. doi: 10.1136/bmj.298.6686.1479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hill R., Williams J., Tattersfield A., Britton J. Change in use of asthma as a diagnostic label for wheezing illness in schoolchildren. BMJ. 1989 Oct 7;299(6704):898–898. doi: 10.1136/bmj.299.6704.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Horn M. E., Reed S. E., Taylor P. Role of viruses and bacteria in acute wheezy bronchitis in childhood: a study of sputum. Arch Dis Child. 1979 Aug;54(8):587–592. doi: 10.1136/adc.54.8.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hughes D. M., McLeod M., Garner B., Goldbloom R. B. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics. 1991 Jan;87(1):54–61. [PubMed] [Google Scholar]
  17. Macdonald J. B., Seaton A., Williams D. A. Asthma deaths in Cardiff 1963-74: 90 deaths outside hospital. Br Med J. 1976 Jun 19;1(6024):1493–1495. doi: 10.1136/bmj.1.6024.1493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Morgan M., Mays N., Holland W. W. Can hospital use be a measure of need for health care? J Epidemiol Community Health. 1987 Dec;41(4):269–274. doi: 10.1136/jech.41.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Halloran S. M., Heaf D. P. Accident and emergency department attendance by asthmatic children. Thorax. 1989 Sep;44(9):700–705. doi: 10.1136/thx.44.9.700. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rose C. C., Murphy J. G., Schwartz J. S. Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment. N Engl J Med. 1984 Mar 1;310(9):573–577. doi: 10.1056/NEJM198403013100906. [DOI] [PubMed] [Google Scholar]
  21. Skoner D. P., Fischer T. J., Gormley C., Martinez R., Bobbitt R. C., Holroyde J. Pediatric predictive index for hospitalization in acute asthma. Ann Emerg Med. 1987 Jan;16(1):25–31. doi: 10.1016/s0196-0644(87)80280-9. [DOI] [PubMed] [Google Scholar]
  22. Storr J., Barrell E., Lenney W. Rising asthma admissions and self referral. Arch Dis Child. 1988 Jul;63(7):774–779. doi: 10.1136/adc.63.7.774. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Storr J., Lenney W. School holidays and admissions with asthma. Arch Dis Child. 1989 Jan;64(1):103–107. doi: 10.1136/adc.64.1.103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Strachan D. P., Anderson H. R. Trends in hospital admission rates for asthma in children. BMJ. 1992 Mar 28;304(6830):819–820. doi: 10.1136/bmj.304.6830.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Warner J. O., Götz M., Landau L. I., Levison H., Milner A. D., Pedersen S., Silverman M. Management of asthma: a consensus statement. Arch Dis Child. 1989 Jul;64(7):1065–1079. doi: 10.1136/adc.64.7.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES