Getting the diagnosis right for patients on the Asthma register – ICST

QI

Allowing you to achieve incremental and measurable changes to make a real difference to patients

Getting the diagnosis right for patients on the Asthma register

The Asthma Diagnostic Review (Project TWO of TWO)

QI projects are built as a TWO-PART component

Part 1

Setup

Here you set up and understand the project, ensuring you have everything in place to start your project

Part 2

Project

Here you have all the tools and resources to keep track of your progress towards completing the project successfully

Better setup, better success

Setup

Getting started

Why is this important?

Data collected from GP practices across Wales suggest that only 76.3% adult patients and 67.4% children and young adult patients on the Asthma registers have evidence of any tests results that can be used to support their diagnosis.

This QI project will ensure that the Asthma register is coded correctly, and every patient who has no evidence of a diagnostic test is invited in for a diagnostic review.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Who is this project suitable for?

This QI project is aimed at primary care teams who have a register of Asthma patients (adult and paediatric).

The aim of this QI project

The aim of this Quality Improvement Project is to record evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma, as demonstrated by at least one of the following:

  • two-week peak flow diary
  • reversible spirometry
  • peak flow steroid trial
  • fractional exhaled nitric oxide (FeNO)

This is the second of two projects, which involves inviting patients in for a review of the Asthma diagnosis if they don’t have any record of any diagnostic tests.

This project should be completed after the first project, which focuses on reviewing the Asthma register.

Getting started

Start by working through the set-up phase of this project, setting yourself a goal according to the time you have available to dedicate to this project, ensuring your team are aware of the project and you have been given the authorisation from your practice manager to complete the project.

Progress through the Set-up phase of your QI project before moving down to the Project phase.

Mark Complete

Readiness

Make sure you have the knowledge and expertise to undertake this project successfully.

If you are confident you have the skills and knowledge to make an accurate diagnosis of Asthma, mark this section as complete using the button below.

If you want to check your level of understanding, or need a refresher, check out the associated learning and assessments for this QI project, in line with the All Wales approach.

Mark Complete
Assessments:
Education programmes:
Mark Complete

Your capacity

Capacity is the most important aspect for the successful completion of any project  – ensure you have the capacity, time and ability to complete your project in a suitable timeframe.

Start by outlining how much time you have to commit to this project.

For example: Over the next six weeks, I will commit one 4-hour clinic (Wednesday afternoon) to completing this project.

And use the calculator provided to work out how many patients you can review in this time.

It is estimated that each patient action for this QI project will take 30 minutes, but adapt locally.

When estimating the time for each patient action on this QI project, think about how long it takes to review a patient’s diagnosis and enter the correct code into the patient’s notes.

When will my project start:

When will my project be completed by:

How much time do I have to dedicate to my project each week

Each patient action for the project will take 30 minutes

Recommended time is 30 minutes per patient.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Mark Complete

Alignment

In order for your project to get underway and to be successful, your manager(s) will need to understand the importance of the project and agree your time commitment.

Name

Job title

Email

Contact 1 details not complete.

Sent email
Responded and signed off project

Name

Job title

Email

Contact 2 details not complete.

Sent email
Responded and signed off project
Mark Complete

Communication pack

It’s important that your colleagues know about the project.

You may want to include colleagues in the project, and they may need to know about other demands on your time. Let them know that you are focusing on QI with these useful resources.

Resources

NACAP Clinical Audit Report – Wales Primary Care

Communication template – colleagues

Communication with colleagues – Presentation template

Mark Complete

Milestone Map

Keep track of your set-up progress and make sure you are on track to getting started with your project with the timeframe you have added in your capacity calculator.

Your Progress

Getting started

Readiness

Your capacity

Alignment

Communication pack

Milestone Map

113

Start Date

Not Set

113

End Date

Not Set

Mark Complete

Project

Project overview

The aim of this QI project

The aim of this Quality Improvement Project is to record evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma, as demonstrated by at least one of the following:

  • two-week peak flow diary
  • reversible spirometry
  • peak flow steroid trial
  • fractional exhaled nitric oxide (FeNO)

This is the second of two projects, which involves inviting patients in for a review of the Asthma diagnosis if they don’t have any record of any diagnostic tests.

This project should be completed after the first project, which focuses on reviewing the Asthma register.

A recap on the evidence

Data collected from GP practices across Wales suggest that only 76.3% adult patients and 67.4% children and young adult patients on the Asthma registers have evidence of any tests results that can be used to support their diagnosis.

This QI project will ensure that the Asthma register is coded correctly, and every patient who has no evidence of a diagnostic test is invited in for a diagnostic review.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Instructions

Project steps

Step 1

Invite all patients without evidence of variability currently on the asthma register (gathered in part one).

Step 2

Perform a test to support the patient’s asthma diagnosis or continue investigations and code appropriately.

Step 1 – Invite patients for a diagnostic review

Ensure you have completed the first QI project in this series ‘Fixing the Asthma register’. From this first project, you should have a list of patients who need a review of their Asthma diagnosis:

  • Those who have no record of diagnostic testing
  • Those who have inconclusive test results to support the diagnosis of Asthma

Step 2 – Perform a test to support the patient’s diagnosis

Start by undertaking a structured clinical assessment to assess the probability of asthma. This should be based on:

  • a history of recurrent episodes (attacks) of symptoms, ideally corroborated by variable peak flows when symptomatic and asymptomatic
  • symptoms of wheeze, cough, breathlessness and chest tightness that vary over time
  • recorded observation of wheeze heard by a healthcare professional
  • personal/family history of other atopic conditions (in particular, atopic eczema/ dermatitis, allergic rhinitis)
  • no symptoms/signs to suggest alternative diagnoses

The next step is to ask the patient to complete a two week Peak Flow Diary, taking one measurement in the morning and one measurement in the evening, and recording the results. This record can be a paper diary, or you can advise your patient to download the Asthmahub or Asthmahub for parents app, with an in-built peak flow diary.

Once the patient returns the PEF diary, record these results in the patient’s notes with the correct code for a peak flow diary:

  • Read Code: 66YY
  • Or SNOMED code: 401011001

Check the Peak Flow Diary for evidence of “dips”; if there are “dips” in the peak flow measurement of more than 20%, the diagnosis of Asthma has been confirmed. Make sure the diagnostic code reflects this:

  • Read Code: H33
  • SNOMED Code: 195967001

For those patients who did not experience significant “dips” in their Peak Flow measurement, try an alternative diagnostic test:

  • Spirometry
  • Spirometry with reversibility
  • Peak flow with reversibility
  • Fractional exhaled nitric oxide

Of course, some patients will be stable on their medication and will not show evidence of objective variability for this reason. Click through the scenarios below for more details.

If you there is a high probability of Asthma following a structured clinical review and the patient demonstrates variable airflow obstruction, you have confirmed the diagnosis of Asthma and should continue managing their asthma.

Make sure the diagnostic code reflects this:

  • Read Code: H33
  • SNOMED Code: 195967001

If you there is a high probability of Asthma following a structured clinical review but the patient does not demonstrate variable airflow obstruction, continue managing the patient according to the Asthma Management Plan.

Remember, tests influence the probability of asthma but do not prove a diagnosis.

If there is a low probability of asthma and/or an alternative diagnosis is more likely, investigate for the alternative diagnosis, reconsidering asthma if the clinical picture changes or an alternative diagnosis is not confirmed. If reconsidering asthma, undertake or refer for further tests to investigate for a diagnosis of asthma.

Recording your progress

For every patient whose record you change, whether that’s changing a patient’s code to reflect their Peak Flow Diary results, or performing a spirometry with reversibility test, be sure to record this in the ‘Progress’ section of the QI platform.

Resources

QI Project Printable Instructions

Resources

Attached below are a selection of resources to support you through your project.

Resources

QI Project Printable Instructions

Patient letter template – invitation for diagnostic review

Recommended Read and SNOMED codes

Progress

Add the number of patients that you have addressed according to this project.

You should see your progress bars increase as you get closer to your goal.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Capacity Calculator

Click on the chevrons for more information on your progress

Project data not set. Please complete your project's capacity settings.

Project data not set. Please complete your project's capacity settings.

Certificate

Your dynamic certificate can be found below. You can generate a certificate at any point during your QI project, and the certificate will be updated when you make further progress.

Sign Off

This QI project can be signed off by yourself.

Please sign off by clicking the button below. This will make your certificate available.

Download Certificate

Profile not complete

Your profile is not complete. Please complete your profile.

Complete your profile now

© Institute of Clinical Science and Technology (ICST) 2020

Support: admin@clinicalscience.org.uk