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

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Abstract
BACKGROUND Discharge planning is becoming an important part of the management 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 practitioner 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 asthma was developed on the wards of a busy children’s hospital. A randomised controlled trial was conducted involving 160 children aged 2–16 years admitted for asthma over a 12 month period. Readmission and A&E reattendance’s over the six months after discharge from hospital were obtained from the hospital computerised information system and general practitioner consultations from practice records. RESULTS Children in the intervention group were significantly less likely to be readmitted to hospital in the next six months than those in the control group (12 of 80 v30 of 80 patients), and significantly less likely to attend 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 problematic asthma (31 of 78v 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 reduced. The programme was designed to be suitable for administration by nursing staff on the children’s wards after a brief period of training.