Childhood asthma in the Emergency Department: An audit

• We have audited a district general hospital emergency department.
• We audited the quality of acute asthma management in children.
• Performance was measured against College of Emergency Medicine standards.
• We found that certain key areas of asthma management are being overlooked.
• An improved integrated care pathway has been suggested and implemented.

IntroductionThe prevalence of asthma has been rising, particularly in younger age groups. In the 12-month period from February 2012 there were 28 deaths due to asthma in children under 18 in the United Kingdom, the majority of which were preventable. The purpose of this audit was to determine how effective our Emergency Department is at managing children presenting with acute asthma.MethodWe undertook a retrospective audit of 50 consecutive presentations to Huddersfield Royal Infirmary Emergency Department between 1 August 2013 and 31 March 2014 that met the inclusion criteria. Whether each patient had initial vital signs, timely initial management, vital signs after initial management, and appropriate further management were audited.ResultsThe majority of patients were male; mean age was 8.5 years. There were deficiencies in measurements for systolic blood pressure (14%), conscious level (30%), and peak flow (46%). Most patients received the correct dose of β2 agonist (96%) and oral or IV steroid (82%). Approximately 50% had further vital signs recorded. Thirty-six per cent were discharged with the correct dose of prednisolone.ConclusionCertain aspects of the management of childhood asthma are being overlooked. We have suggested an improved integrated care pathway that we feel will improve the deficiencies highlighted.