title: An audit of hospital discharge letters in patients admitted with acute asthma. Tayside Asthma Audit Group.
abstract: The management of patients following discharge with acute asthma is dependent on effective communication with general practitioners. A retrospective audit was therefore performed on copies kept of 81 typed discharge letters with a diagnosis of acute asthma between March and October 1991. A subset of 42 interim (handwritten) letters were also audited where case notes could be retrieved. Details on clinic follow up were also obtained from the case notes (n = 42). In the typed letter documentation of severity and treatment of the acute attack was accurate in most cases. Information concerning a precipitating factor was provided in 54% of cases and a smoking history in 57%. Deficiencies were found in specifying inhaler delivery devices (40% recorded), and whether inhaler technique had been formally assessed whilst in hospital (17%). Drug prescribing on discharge was as follows: oral steroid (69%), inhaled steroids (77%), inhaled B2-agonists (92%), theophylline slow release (38%), salbutamol controlled release (20%), and antibiotics (30%). The implementation of a self-management plan and domiciliary peak flow was mentioned in 66% of the letters. The interim letter was generally poor in particular for mention if discharge peak flow (2%), clinic follow-up (64%) and prednisolone regime (61%). Mean +/- s.d. time for clinic follow-up (n = 42) was 4.7 +/- 1.7 weeks (range 1-13 weeks) with 24% non-attendance. Thus, improvements in discharge letters are clearly required for optimum continuity of care in the community.
authors.affiliation: Department of Respiratory Medicine, Kings Cross Hospital Dundee.
authors.forename: B J
authors.initials: BJ
authors.lastname: Lipworth
authors.forename: J
authors.initials: J
authors.lastname: Allan
authors.forename: C M
authors.initials: CM
authors.lastname: Jackson
authors.forename: P D
authors.initials: PD
authors.lastname: Dhillon
authors.forename: J H
authors.initials: JH
authors.lastname: Winter
authors.forename: R A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D000208:Acute Disease; D001249:Asthma / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008485:Medical Audit; D008500:Medical Records Department, Hospital; D010351:Patient Discharge; D012189:Retrospective Studies