Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project


  • Farkhunda Waqas Specialty Registrar, Emergency Medicine, Homerton University NHS Hospital UK
  • Jennifer Cousins Advanced Nurse Practioner, Homerton University NHS Hospital UK
  • William Niven Consultant Emergency Medicine, Homerton University NHS Hospital UK
  • Saira Butt Specialty Trainee, Emergency Medicine, Homerton University NHS Hospital UK
  • Colin Wittstock Clinical Fellow, Emergency Medicine, Homerton University NHS Hospital UK



Asthma, Emergency Medicine, Inhaler technique


Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.
Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.
Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).
Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department.





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