S44 Are children admitted with near-fatal asthma receiving the core elements of care at discharge? Results from NRAP, the national respiratory audit programme

Background NRAP collects data on acute asthma admissions from hospitals in England and Wales. This allows for monitoring quality of care, outcomes for children and young people (CYP) with asthma, and identifying areas for improvement. Multiple metrics are measured, including whether the Personalised Asthma Action Plan (PAAP) was reviewed or issued, the inhaler technique was checked, and the patient was referred for a follow-up with an asthma-trained clinician. These key performance indicators are aligned with the recommendations of the National Bundle of Care for CYP with Asthma.Aim To establish whether children with life-threatening asthma attacks receive the nationally recommended core elements of care at discharge.Methods We analysed the care delivered to children in 2023–2024, in NRAP audit participating hospitals, who: 1) were admitted to Intensive Care Unit (ICU) or High-Dependency Unit (HDU), or 2) received intravenous (IV) treatment for acute asthma. We audited the core elements of discharge: 1) receiving a PAAP, 2) having the inhaler technique checked, and 3) being referred for a 2-day or 4-week follow-up at discharge.Results In 2023–24 a total of 14,311 CYP were admitted with asthma, 2,871(20% of all admissions) were given IV-medication, of which 1,218(42%) were then admitted to ICU, HDU, or both. 54% of the CYP with asthma who were on IV-treatment received PAAP, 69% had their inhaler technique checked, and 59% were referred for a 2-day or 4-week follow-up at discharge. In the cohort of 1,404(10% of all admissions) CYP admitted to ICU or HDU, 57% received PAAP on discharge, 71% had their inhaler technique checked, and 54% were reported to have been referred for either a 2-day or 4-week follow-up appointment.Conclusions NRAP data show that in the group of the sickest children, admitted with near-fatal asthma, the standards of care delivered are suboptimal. Targeted quality improvement programs should be implemented at the Trust level to improve the care for CYP and reduce the risks of future asthma attacks.