With respiratory care such a high NHS priority and a huge burden, both on chronic and emergency care services, it is with great enthusiasm that SASH are finalising plans for an Integrated Care Pathway (ICP) for all adult asthma patients who enter A&E for acute care.
ICPs are nothing new in healthcare, and national treatment guidelines for asthma already exist (British Thoracic Society Guidelines).The purpose of the new Asthma ICP rests on issues around patient flow, specialist management, and working to reduce A&E admissions and re-admissions.
Currently a specialist respiratory nurse sees every COPD admission to SASH before being discharged home. The same is not true for asthma patients, who are often treated and observed appropriately in the A&E department before discharge. The tariffs around asthma admissions (£1000-£1700) are much less than that for COPD admissions (£3000+), reflecting average duration of stay and complexity of cases. However asthma patients frequently exhibit A&E ‘revolving door behaviour’ and addressing this is key when implementing the new ICP for asthma.
The ICP will, in effect, allow A&E to treat asthma patients with the respiratory nurse 'on their shoulders'. It places a specialist emphasis on treatment and covers a comprehensive treatment pathway for patients - standardising care and ensuring key investigations are carried out. These, most importantly, are used within the asthma management plan with which the patient is discharged back to primary. Baseline treatment and compliance are cornerstones of the therapy protocol, whilst ensuring quality outcomes and preventing re-admissions are the main aims of this core Asthma ICP.
SASH are working closely with new Respiratory Consultant, Ed Cetti, who designed the ICP, drawing from the current BTS guidelines and other, similar pathways already in use elsewhere.
Dr Cetti says about the protocol, "Effective asthma management requires the right treatment at the right time and patient involvement in their management is key. This Asthma ICP will ensure effective stepping-up of treatment after an attendance with acute asthma, will help improve integration between primary and secondary care and should improve outcomes for the patients and the hospital."
Omar Ali, Formulary Development Pharmacist at Surrey & Sussex Healthcare NHS Trust, who has been involved in the development of the asthma ICP, remarks about the project: “This is the new way SASH Pharmacy are working within the new NHS Framework to strive for improved quality of care and to reduce inefficiencies within the system. Reducing A&E admissions/re-admissions can only be good news for the patient - and the commissioning of good quality prescribing within specialist treatment modalities is the pathway I am looking to create in 2011.”
In March, Omar Ali, the Respiratory Team and the SASH CEO and Director of Finance will meet with ESyDoc to discuss the proposed Asthma ICP- one of the first A&E SASH Protocols that will be implemented and delivered with close liaison from GP Commissioning Leads.
