Department audit of inpatient management of asthma

Rising asthma morbidity and mortality worldwide has prompted the recommendation of guidelines for its management. There has also been recent interest in the role of medical audit in assessing the effectiveness of guidelines, and in identifying deficiencies in clinical practice. We disseminated guidelines for the inpatient management of asthma to our department in March 1994, and subsequently performed a criterion-based audit in which we measured our performance in fulfilling various criteria deemed essential for good asthma management. Three periods in time were audited: a five-week period in March/April 1993 before the existence of guidelines (n = 22), the same period in March/April 1994 (n = 27), and the month of August 1994 (n = 17). The introduction of guidelines resulted in definite improvement in history-taking, physical examination, management, review, monitoring and patient fulfillment of pre-discharge criteria. Specific deficiencies identified were underuse of peak flow measurements, which improved after guidelines; and under prescription of oxygen, which persisted despite the guidelines. No difference was noted in terms of the quality outcome indicators of length of hospital stay, complications of procedures, hospital incidents, morbidity, mortality or visits to the A & E. There was, however, an encouraging drop (although not statistically significant) in the one-month readmission rate from 13.6% in 1993, to 7.4% and 5.9% in 1994, after the introduction of guidelines.