A criterion based audit of inpatient asthma care. Closing the feedback loop

We have assessed the care of patients admitted to a specialist respiratory medical ward acutely ill with asthma, using a criterion based audit derived from a standard management protocol already in use in our hospitals. The audit was first performed from 01.01.90 to 31.08.90; after implementing certain changes, the audit was repeated from 1.12.90 to 31.1.91. Special attention was paid in each audit review to pre-admission measures, inpatient management and pre-discharge and follow-up management. During both audit periods, of a total of 78 patients, 74 patients gave a reason for the worsening of their asthma; 59 had had PEF measured and 58 had received systemic steroids before admission; 77 patients had full objective assessment of severity on admission; 76 patients were discharged on oral steroids; 62 had PEF meters for home monitoring; and 65 of the 68 patients who lived in our district were seen again within six weeks as outpatients in the chest clinic. However, only 30/55 (54%) had PEF variability of 20% or less (our criterion for appropriateness of discharge, in the first audit period) and only 32/55 had a written check on their inhaler technique in the first audit period. By relaxing our PEF criterion for discharge (in line with national guidelines), by introducing a stamp for recording that inhaler technique had been checked, and with encouragement and exhortation from senior staff, we improved our performance of meeting the set standards to 17 of 23 (74%) patients for PEF variability and to 22 of 23 (96%) patients for written check on inhaler technique in the second audit period.(ABSTRACT TRUNCATED AT 250 WORDS)