Quality standard
Quality statement 4: Follow-up by general practice after emergency care
Quality statement 4: Follow-up by general practice after emergency care
Quality statement
People who receive treatment in an emergency care setting for an asthma attack are followed up by their general practice within 2 working days of discharge. [2013, updated 2018]
Rationale
People who have recently had emergency care for an asthma attack may be at risk of another attack. Timely follow‑up in general practice after discharge from emergency care allows healthcare professionals to check that the asthma is responding to treatment, to explore the possible reasons for the attack and to give support and advice about reducing the risk of further attacks.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Process
a) Proportion of cases of asthma attack treated in an emergency care setting notified to the person's general practice.
Numerator – the number in the denominator notified to the person's general practice.
Denominator – the number of cases of asthma attack treated in an emergency care setting.
Data source: Local data collection, for example, audit of patient health records. Data on community follow‑up requests within 2 working days is included in the Royal College of Physicians National Respiratory Audit Programme (NRAP) for adults and children as an element of the patient's discharge.
b) Proportion of notifications of asthma attack treated in an emergency care setting followed up by a general practice within 2 working days of discharge.
Numerator – the number in the denominator that are followed up by a general practice within 2 working days of discharge.
Denominator – the number of notifications of asthma attack treated in an emergency care setting.
Data source: Local data collection, for example, audit of patient health records.
Outcome
a) Rate of re-attendance within 7 days of a previous attendance in emergency care for asthma.
Data source: Local data collection, for example, audit of patient health records. Data on A&E re-attendance within 7 days is included in NHS England's Accident and Emergency Quality Indicators.
b) Rate of hospital attendance or admission for asthma attack.
Data source: NHS Digital's Hospital Episode Statistics includes data on admissions and A&E attendances for asthma attack.
c) Mortality rate for people with asthma.
Data source: Local data collection, for example, audit of patient health records. Office for National Statistics (ONS) deaths registered in England and Wales provides data on deaths where asthma was the underlying cause of death.
What the quality statement means for different audiences
Service providers (such as A&E departments, out-of-hours services, walk‑in centres and general practices) ensure that processes are in place to notify the person's general practice when treatment for an asthma attack has been provided in an emergency care setting. Once notified, general practices ensure follow‑up takes place within 2 working days of discharge. General practices ensure that staff who follow‑up with people who have had an asthma attack are trained in asthma care.
Healthcare professionals (such as doctors, nurses, pharmacists and healthcare assistants) notify the person's general practice when they provide treatment in an emergency care setting for an asthma attack. Healthcare professionals in general practices ensure that follow‑up takes place within 2 working days of discharge from emergency care.
Commissioners commission emergency care services that have processes in place to notify the person's general practice when treatment is provided for an asthma attack. Commissioners ensure that there is sufficient capacity for general practice to follow‑up within 2 working days of discharge. Commissioners could consider introducing a local quality improvement scheme to encourage the pathway to be established.
People who have emergency treatment for an asthma attack are checked by a healthcare professional from their GP surgery within 2 working days of discharge. This is to check that their treatment is working and help them to understand why their asthma got worse and how to stop it happening again.
Source guidance
British guideline on the management of asthma. British Thoracic Society and Scottish Intercollegiate Guidelines Network guideline 158 (2019), good practice points 9.6.3, 9.9.7, and annexes 3 and 7. This content is included on the Right Decision Service for hospital discharge and follow up of acute asthma in adults, second-line treatment of acute asthma in children (discharge planning) and algorithms on management of acute asthma in children in the emergency department and management of acute asthma in adults in general practice.
Equality and diversity considerations
Healthcare professionals in emergency care should ensure that alternative follow‑up arrangements are made for people who are not registered with a general practice. For example, people experiencing homelessness may be followed-up via the specialist homelessness multidisciplinary team (for more information see NICE's guideline on integrated health and social care for people experiencing homelessness, recommendation 1.3.4).