AUDIT STRATEGIES TO REDUCE HOSPITAL ADMISSIONS FOR ACUTE ASTHMA

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alex andra Hospital. In the first study the on call senior house officer (S HO) was replaced by an experienced registrar and over a four month per iod 53 children out of 158 were sent home from the receiving room comp ared with six out of 39 seen by the SHOs. In the second study an SHO t raining programme was established together with a home treatment packa ge. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards f illed in by parents indicated that children sent home without admissio n fared no worse at home than those admitted and then discharged for t he two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more ch ildren to be safely managed in the community.