Structured discharge procedure for children admitted to hospital with acute asthma: a randomised controlled trial of nursing practice

Background-Discharge planning is becoming an important part of the manageme nt of childhood asthma in hospital. Readmission to hospital, although often inevitable, might represent a failure of the opportunity for intervention presented by a brief period of supervised care in hospital. Aim-To examine the impact of a structured, nurse-led discharge package for children admitted to hospital with acute asthma on readmission to hospital, reattendance at the accident and emergency (A&E) department, and general p ractitioner consultations for asthma. Methods-A structured nurse-led discharge package, consisting of a 20 minute patient education programme and self management plan for children with ast hma was developed on the wards of a busy children's hospital. A randomised controlled trial was conducted involving 160 children aged 2-16 years admit ted for asthma over a 12 month period. Readmission and A&E reattendance's o ver the six months after discharge from hospital were obtained from the hos pital computerised information system and general practitioner consultation s from practice records. Results-Children in the intervention group were significantly less likely t o be readmitted to hospital in the next six months than those in the contro l group (12 of 80 v 30 of 80 patients), and significantly less likely to at tend the A&E department (6 of 80 v 31 of 80). Significantly fewer children in the intervention group had visits to their general practitioner for prob lematic asthma (31 of 78 v 72 of 77 for whom data were available). Conclusion-By delivering the simplest form of education and support during a child's stay in hospital, readmissions over a six month period were reduc ed. The programme was designed to be suitable for administration by nursing staff on the children's wards after a brief period of training.