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The UK's primary care sustainability network

2. Improving coding of asthma exacerbations

In order to correctly identify asthma patients who may be at risk of poor control and also make future searches to identify patients at risk of poor control (disease control project 1) more accurate, it is important to look at whether asthma exacerbations are being correctly coded.

The process

Step 1: Identify the process for adding clinical codes

How are codes added from scanned hospital letters added in your practice? Whose job is this? Admin staff who scan, clinicians?

Step 2: Identify if coding is being done correctly

How are hospital  letters which may indicate an asthma exacerbation currently coded?

  • Is an asthma exacerbation code used?
  • If patients receive a course of oral prednisolone, is this logged into the record?

If a patient attends general practice with an asthma exacerbation how is this coded in the notes?

You may wish to audit the notes of asthma patients known to have recent exacerbations to understand more about the process in your practice and if there is variation between the practice team.

Step 3: Training for staff

If coding staff are not clinical what training do they need to help them code an asthma exacerbation correctly?

If coding staff are clinical, are they aware of how to code an asthma exacerbation or record oral prednisolone use?

You may wish to bring this to a practice meeting to discuss this.

Step 4: Follow-up

How will patients be followed up if they have had an asthma exacerbation?

Will they need to be put on a clinician’s phone list for review 48 hours after the exacerbation? Who is the best person to conduct the follow-up review? Is this the on-call doctor? Or the asthma nurse? Your practice pharmacist? Discuss this at a clinical meeting.