An audit of hospital discharge letters in patients admitted with acute asthma. Tayside Asthma Audit Group.
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.
Lipworth
B J
BJ
Department of Respiratory Medicine, Kings Cross Hospital Dundee.
Allan
J
J
Jackson
C M
CM
Dhillon
P D
PD
Winter
J H
JH
Clark
R A
RA
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