Quality of acute asthma care: an audit of clinical practice in a Victorian health service.

OBJECTIVES: To describe acute asthma care at a large health network in metropolitan Melbourne, and evaluate the extent to which Emergency Department (ED) treatment was consistent with National Asthma Council guidelines.

DESIGN: A retrospective audit of medical records for patients admitted between July 2017 and June 2019.

SETTING: Two tertiary campuses within the Western Health network, located in Melbourne, Victoria.

PARTICIPANTS: Adult patients admitted to hospital for at least 12 hours, with a primary discharge diagnosis of asthma.

RESULTS: 493 admissions were included in the analysis, representing 392 individual patients. 71% patients were female and 27% were current smokers. 96% patients had a prior asthma diagnosis, 63% had a previous hospital presentation, and 75% were prescribed an inhaled preventer. In ED, systemic corticosteroids and inhaled salbutamol were prescribed in 65% and 82% admissions respectively; adjunctive treatments included ipratropium (67% admissions), magnesium sulfate (30%), adrenaline (11%) and non-invasive ventilation (9%). Overall, ED care was guideline concordant in 59% admissions. On the wards, treatments prescribed within 24 hours of admission included corticosteroids (90% admissions), salbutamol (84%), ipratropium (64%) and inhaled preventers (63%). The proportion of patients prescribed these treatments, as well as documented follow up (for example, asthma action plans), varied significantly dependent on treating specialty.

CONCLUSION: The emergency treatment of patients with acute asthma frequently deviated from guidelines, and there was significant variation in inpatient treatment. Quality improvement initiatives which incorporate structural changes are required to improve asthma care. This article is protected by copyright. All rights reserved.