Reducing re-admission for asthma: impact of a nurse-led service.

High rates of re-admission of children with acute asthma led to the establishment of a nurse-led service in one hospital in England. Improved approaches to care, discharge planning and subsequent management were introduced based on the BTS/SIGN guideline for asthma management. These approaches included a reducing regime for salbutamol inhaler treatment, consistent assessment of need for regular preventer treatment and of 'step up' asthma control measures at home. Review of inhaler technique is particularly important to ensure that the appropriate drug delivery device is used depending on the age of the child. Telephone follow-up is used to re-enforce information provided prior to discharge. Subsequent follow up in the nurse-led clinic provides an opportunity to review the child's home management and effectiveness of any treatment changes. Audit data indicate a reduction in re-admission rates for children with asthma from 22 per cent to around six per cent.