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Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland.
Hannah, Romanie; Chavasse, Richard J P G; Paton, James Y; Walton, Emily; Roland, Damian; Foster, Steven; Lyttle, Mark D.
Afiliación
  • Hannah R; Children's Emergency Department, Royal Alexandra Children's Hospital, Brighton, UK romanie.hannah1@nhs.net.
  • Chavasse RJPG; Respiratory Paediatrics, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Paton JY; School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
  • Walton E; Children's Emergency Department, Royal Alexandra Children's Hospital, Brighton, UK.
  • Roland D; SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.
  • Foster S; Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Lyttle MD; Children's Emergency Department, Royal Hospital for Children, Glasgow, UK.
Arch Dis Child ; 109(7): 536-542, 2024 Jun 19.
Article en En | MEDLINE | ID: mdl-38627029
ABSTRACT

OBJECTIVE:

Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.

DESIGN:

Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.

SETTING:

Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI). MAIN OUTCOME

MEASURES:

Describe practice and variation in discharge advice, treatment recommendations and safety netting provision.

RESULTS:

Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) 'nearly always' assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided 'fixed' bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).

CONCLUSIONS:

There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Alta del Paciente / Asma / Broncodilatadores / Ruidos Respiratorios / Servicio de Urgencia en Hospital Límite: Child / Child, preschool / Female / Humans / Infant / Male País/Región como asunto: Europa Idioma: En Revista: Arch Dis Child Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Alta del Paciente / Asma / Broncodilatadores / Ruidos Respiratorios / Servicio de Urgencia en Hospital Límite: Child / Child, preschool / Female / Humans / Infant / Male País/Región como asunto: Europa Idioma: En Revista: Arch Dis Child Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Reino Unido