Abstract

Background:
Despite established standards for ward and ED discharge letters, the quality of paediatric asthma discharge letters remains variable, and information can lack salient details, including management and follow-up. There is a need for a consensus on the information and structure required for discharge letters to ensure safe and effective handover of care to the primary care clinician, child’s school or parent/carer.

Aim:
To establish agreed core elements for standardised paediatric asthma discharge letter template.

Method:
The National Respiratory Audit Programme Children and Young People Asthma Team used the Delphi method, comprising of multiple survey rounds, to secure a consensus from subject experts. We recruited clinicians from all healthcare settings involved in paediatric asthma care directly and via national groups: British Paediatric Respiratory Society, British Thoracic Society, Association of Respiratory Nurses, Primary Care Respiratory Society, School and Public Health Nurses Association, National Paediatric Respiratory and Allergy Nurses Group, and teams participating in the National Respiratory Audit Program audit. For Patients and Public Involvement and Engagement, we consulted the RCPCH.

Initial results:
55 participants, including clinicians (general practitioners, general and respiratory paediatric consultants, nurses, pharmacists), and parents/carers were asked to identify the top 3 discharge elements out of a list of 25, which were established during initial open consultation with stakeholders. Each choice was then graded by the level of importance on a scale of 1-5. 71% of participants identified red flags (e.g. previous hospitalisation, high salbutamol use), as the most important element, followed by treatment plan (31%), record of previous exacerbations/hospitalisations (31%), inhaler technique check and provision of asthma action plan (27%), hospital treatment (27%), clear diagnosis (22%), and instructions for GP (24%). The remaining elements were scored as of lower relevance, with less than 20% of participants voting for them.

Conclusions:
This initial DELPHI round to develop best practice standards for CYP with Asthma identified patient red flags as the most important core element of the discharge letter; further rounds are required to reach consensus on the other elements, which will inform the outline of the discharge letter template.