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

Structure

a) Evidence of local arrangements to ensure that emergency care settings notify the person's general practice following treatment for an asthma attack.

Data source: Local data collection, for example, service protocols.

b) Evidence of local arrangements to ensure that general practices follow‑up people treated in an emergency care setting for an asthma attack within 2 working days of discharge.

Data source: Local data collection, for example, service protocol.

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 asthma attack treated in an emergency care setting.

Data source: Local data collection, for example, audit of patient health records. Data on follow‑up requests is included in the National Asthma and COPD Audit Programme (NACAP) adult asthma audit and children and young people asthma audit 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 is included in NHS Digital'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. National data on the under 75 mortality rate from respiratory disease is included in NHS Outcomes Framework – indicator 1.2 available from NHS Digital's Clinical indicators.

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 places within 2 working days of discharge. General practices ensure that staff who follow‑up 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 (clinical commissioning groups and NHS England) 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 at 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

Management of asthma (2016) British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) clinical guideline 153, recommendations 9.6.3, 9.9.7, and annexes 3 and 6

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, because they are homeless.