P81 The efficacy of a nurse led, primary care, acute asthma service in reducing short stay hospital admissions

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Current interventions to decrease acute asthma admissions during childhood have achieved limited benefits. We hypothesised that a community asthma nurse service, providing rapid access consultations and an out of hours telephone service, might be an effective strategy in reducing potentially avoidable short stay hospital admissions (<24 h). We conducted a prospective observational study of the impact of such a service over a 1-year period (2010) using the previous 12 months as a historical control group (2009). There were 176 (64%) fewer short stay admissions during the intervention period compared with the previous year. The reduction in admissions resulted in gross savings to the NHS of approximately £125 000 based on the national payment by results tariff of £709 per asthma admission. There were 149 referrals to the asthma nurse service. 53% were self-referrals. 39 children with poorly controlled asthma were referred by the asthma nurse for hospital assessment. Of these 38 were subsequently admitted for in-patient treatment and 1 was discharged from the emergency department after 4 h. 21 children were judged to be relatively mild and would not have needed hospital admission if referred. 89 cases would either have been referred for hospital assessment or families would have self-referred to hospital if the service was not available. For this group it was judged by the attending nurse that their interventions had avoided hospital admission. The reduction in short stay admissions was impressive and greater than the number of patient episodes that were addressed by the service. We suspect that this was a knock on effect of good practices being repeated and disseminated within the community without necessarily re-engaging with the service. The number of non-elective short stay asthma admissions has continued to fall in 2011. From January to May 2011 there were just 29 short stay admissions which is 62% less than the 47 admissions during the same period in 2010. We suggest that this model of care is applicable to many other localities and could result in substantial cost savings to the NHS while providing appropriate care to patients in their homes.

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