Background The British Thoracic Society (BTS) recommends that children under 5 years of age who are admitted with suspected asthma should be discharged as per the BTS Asthma Discharge Care Bundle since this improves patient outcomes¹. Many children with suspected asthma are prescribed inhaled corticosteroids (ICS) to reduce airway inflammation². We suspected substandard discharge care of children under 5 hence decided to audit our practice.

Objectives

1. To assess compliance with the BTS asthma discharge bundle, for children under 5 admitted with suspected asthma, who were discharged on inhaled corticosteroids.

2. To improve and standardise the discharge planning of this group of children.

Methods Children with a discharge diagnosis of viral induced wheeze (VIW) or asthma, between 01/12/2018 and 31/11/2019, were provided by the hospital information department. Patient notes on iSOFT electronic patient record system were reviewed and those discharged on ICS were identified. From these, every other case in ‘date of admission order’ was selected and audited against the BTS bundle. This retrospective audit was approved by the trust.

Results Out of a total of 447 children discharged with VIW or asthma under the age of five, 123 patients were discharged on ICS and of these 62 were randomly selected for audit.

Only 9/62 (15%) patient records were 100% compliant with the BTS bundle. 22/62 (35%) were less than 50% compliant. 17/62 (27%) did not have any follow up (neither hospital nor community).

Conclusions The BTS discharge standards for children under 5 years with suspected asthma were not followed in the majority of children. The lack of follow up of many children who were discharged on ICS is particularly concerning, potentially sentencing them to long term ICS and consequent risk of side effects.

We recommend that shortfalls identified by this audit be addressed followed by re-audit after a year.

References

1. British Thoracic Society. Improving Outcomes in Asthma- Asthma Care bundle. [Online] 22/4/2016. https://www.brit-thoracic.org.uk/quality-improvement/clinical-resources/asthma/

2. Price, John. The role of inhaled corticosteroids in children with asthma. BMJ. (2000), Vol. 82,2.