P68 Are hospital organisational factors associated with the delivery of the adult asthma discharge bundle? An analysis of data from the national respiratory audit programme

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Introduction The completion of an asthma discharge bundle (DCB) is a core component of high-quality care for patients admitted with asthma exacerbations. However National Respiratory Audit Programme (NRAP) data shows that 20% of patients do not receive a DCB during their admission.1 Aim 1. Describe the variation in delivery of the asthma DCB across hospitals in England & Wales, 2. Investigate which organisational-level factors are associated with DCB completion. Methods We used data from the 2023–24 NRAP to compare DCB completion in patients who had data submitted to the clinical audit for their exacerbation (n=18884 admissions). We extracted data from the 2024 NRAP snapshot Organisational Audit to compare key organisational factors between the top 25% performing hospitals for DCB completion vs. other hospitals. Results The proportion of patients receiving a DCB varied greatly between hospitals, with a median of 80% (interquartile range 45–96%) (figure 1). There was similar variation across integrated care systems, from 6% to 100%. The top 25% of hospitals for delivery of the asthma DCB reported having higher median respiratory nurse specialist (RNS) per 300 adult asthma admission (5.7 vs. 4.5), and higher weekend RNS availability (31% vs 20%), when compared to the other 75% of hospitals. Conclusion There is concerning variation in the reported delivery of asthma discharge bundles across England & Wales. Whilst there are likely to be a number of complex factors associated with DB delivery, services should consider addressing RNS staffing and 7-day working, in efforts to improve the delivery of basic asthma care. Reference National Respiratory Audit Programme, Royal College of Physicians. ‘Breathing well. An assessment of respiratory care across England and Wales.’ 2024.

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