AN AUDIT OF HOSPITAL DISCHARGE LETTERS IN PATIENTS ADMITTED WITH ACUTE ASTHMA

The management of patients following discharge with acute asthma is de pendent on effective communication with general practitioners. A retro spective audit was therefore performed on copies kept of 81 typed disc harge letters with a diagnosis of acute asthma between March and Octob er 1991. A subset of 42 interim (handwritten) letters were also audite d where case notes could be retrieved. Details on clinic follow up wer e also obtained from the case notes (n=42). In the typed letter docume ntation of severity and treatment of the acute attack was accurate in most cases. Information concerning a precipatating 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 in haler technique had been formally assessed whilst in hospital (17%). D rug prescribing on discharge was as follows: oral steroid (69%), inhal ed steroids (77%), inhaled B2-agonists (92%), theophylline slow releas e (38%), salbutamol controlled release (20%), and antibiotics (30%). T he 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 fol low-up (64%) and prednisolone regime (61%). Mean +/- s.d. time for cli nic 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 r equired for optimum continuity of care in the community.