Document resource
Why did you do this work? Wheeze is a common paediatric presentation however there is a lack of evidence regarding the optimum salbutamol weaning regime for discharge. Traditionally, a fixed salbutamol weaning regime instructs parents to give fixed doses that wean over 3 days (e.g. 10 puffs 4 hourly for 24 hours, then 6 puffs 4 hourly for 24 hours, then 2 puffs 4 hourly for 24 hours.)Previous work in our department established that an ‘as required’ salbutamol weaning regime on discharge utilised less salbutamol, was preferred by parents and there were no major changes in reattendance rates in a small cohort. (Connett, 2023).What did you do? In September 2022, an ‘as required’ salbutamol regime was implemented for all children discharged home in our institution following a diagnosis of wheeze in CED. Parents were given verbal and written advice on when to give salbutamol in response to their child’s symptoms. (Harper, 2022) This project evaluated whether reattendance rates increased post-intervention over a longer period and in a larger cohort of patients.A retrospective review was undertaken of all patients diagnosed with wheeze (viral induced wheeze or asthma) between September 2021 and August 2022 (pre-intervention) and September 2022 and August 2023 (post-intervention). The primary outcome was the numbers of patients who reattended within 24 hours and secondary outcomes were the numbers of patients who reattended within 1-7 days, length of time in ED and admissions to HDU or PICU.What did you find? 1117 cases attended CED with wheeze pre-intervention (median age 3.2 years, IQR 1.9 – 5.3 years) and 1400 cases post intervention ages (median age 3.6 years IQR 2.1 – 6.6 years). In the pre-intervention group 23/1117 (2.1%) reattended within 24 hours and 33/1117 (3%) reattended within 1-7 days. 1 reattendance was admitted to HDU, none to PICU. The average time following reattendance in the department for the pre-intervention group was 7.9 hours.In the post-intervention group 18/1400 (1.3%) reattended within 24 hours and 21/1400 (1.5%) reattended within 1-7 days. No cases were admitted to HDU/PICU. The average time following reattendance in the department for the post-intervention group was 7.5 hours.According to χ2 testing there was no difference in the rates of reattendance at 24 hours (χ2 [1, n=2517] = 2.319 p = 0.13). There was a reduction in the rates of reattendance within 1-7 days following the intervention (χ2 [1, n=2517] = 6.259 p = 0.01).What does it mean? In this retrospective study, following the introduction of an ‘as required’ salbutamol weaning regime on discharge there was no increase in reattendance rates for patients with wheeze and there is evidence that reattendance rates reduced within 1-7 days. This suggests that an ‘as required’ salbutamol regime on discharge does not lead to an increase in reattendance rates.References Connett G, Harper S, Raut B, James D. Hospital discharge using salbutamol as required after acute attacks of wheeze in children: a service evaluation. Arch Dis Child. 2023 Dec 14;109(1):2. doi: 10.1136/archdischild-2023-325703. PMID: 37918898; PMCID: PMC10803954.Harper S, Connett G, James D. Wheeze discharge advice. Wessex Healthier Together. 2022 November. https://www.what0-18.nhs.uk/application/files/6916/8088/2923/Wheeze_discharge_plan_Version_13_Nov_2022__FINAL_1.pdf (accessed 30 Sep 2024)