Anybody have a direct pass onto the ward for asthma/nebuliser use. Instead of going via A+E?

[BackToB4Beatrice]

DD, 2.6, has just been official diagnosed asthmatic, although we have been in and out of hospital since she was 4months old. We have been admitted 6 times, and have stayed for up to 8 nights.
In between these admissions we have been to A&E for several hours, used the nebs, until her stats are better and then gone home.
After a horrendous attack at the GPs, where we were then blue lighted to A&E, we were diagnosed, and I had to go to a meeting with the "asthma nurse". Who basically just told me that asthma shouldnt be underestimated and explained when to up and down the puffers. She also told me that if she has an attack/episode to take her to hospital if I am having to use sabutamol more than every four hours.

This happend this week, so I went to A&E, and after a while the doctor suggested that we possibly should have direct pass so a not to come via A&E.
Unfortunately he said this a little off the record and suggested I talk to the nurse at the GPs.

Does anybody know anything about this? Or how I go about it?
I feel like I have been fighting for 2 years to get a DX, in order to have puffers on repeat prescription etc, and after the doctor suggested this I feel like the GPs are maybe not being pro active enough?

TIA for any advice or additional info.

I thought a diagnosis of asthma was never made before a child was about 5 years old

We've had a "direct" line back onto a childrens' ward but only ever after being sent home post-admission.

Have you seen a paediatric respiratory dr at the hospital or have you just been using the GP in between visits to A&E?

If not I'd be pushing for a referral to the hospital for a proper "diagnosis", care plan, and see if you can't get on top of it with preventative meds.

Asthma IS diagnosed in the

Sorry, just re-read and see that you have a diagnosis.

Do you see someone at the hospital outside of the emergency admissions?

Do you have any idea what your dd's asthma triggers are?

Sorry to hear thst you're having such a tough time. There is a long running thread in childrens' health for parents of children with asthma which may be good to join :)

Mrspies I would be interested in where you got the information that asthma is diagnosed in the under 5s. It is referred to as pre-school wheeze.

Crystal, you are wrong I am afraid. It is rare to get a diagnosis but in the more serious cases they certainly do diagnoses Ds was diagnoised at 12 months after 5 admissions and a lot of day to day problems.

In answer to the op, we are lucky that our hospital has a peads a and e which is all connected to the children's ward and the observation ward so going in through a and e is quick and easy for us as the system they have works so well.

Hi
Ds was diagnosised at 9 months with ashtma and not pre school wheeze or viral induced wheeze. He had day to day problems and just not when he was ill. He is under GOSH so has direct acces to our local childrens ward with out going though A&E. It has only been done since he was seen under GOSH. Before we had to go though a&E.

Sorry also ment to add that he has a home neb

My ds some 17 years ago was diagnosed with asthma at 9 months ....we had an 'arrangement' with the hospital that should he get to the point he needed hospital treatment he was to go directly to the ward and not A&E,this was also the 'plan' when we moved area and ds2 became ill with a totally different problem.

Hi,

We have bee diagnosed I'm afraid. They were reffered to as 'wheezy episode' up until the last bad one where we were then given both inhalers on repeat prescription, an it was called an asthma attack.

I seem to have an unofficial "care plan", basically the "asthma nurse" has sat done with me and told me how much I can use the inhalers, how to treat a wheeze at home, when we need intervention, and so on.

But, as of yet, I have not seen any type of consultant or been referred in anyway.

SIRZY- we also have a separate children's A&E, and they do whizz through it really quickly. But it still took 2 1/2 to get on the nebuliser. Not that I'm complaining, she was pretty well, her sats were at 91, not in the eighties, but I still feel, we are seeing somebody different every time, and the junior doctors just seem to do as I suggest- drugs/nebulisers etc.

Am just thinking maybe I need to push for a refera?

MrsPles- triggers seem to be, some dogs hair, house dust, being run down, and obviously a simple cold will turn in to quite a big problem nearly always needing a stay in hospital, steroids and O2 for a couple of days/nights.

Thanks for all your posts.

hello MyDs (nearly 2 actual, 21 months corrected age) has a diagnosis of Asthma, he got it at about 13 months after having had HIB.

We have direct access to our children's ward, but in effect what that does is cut out some of the traige/admission, as well as get he notes together in the case of an attack. We have a hospital number for DS, and if we then call the ward they fast bleep the relevant registrar. We then take DS to the hospital and they know they are expecting us, and have(hopefully) got the notes together fom wherever they are) the relevant registrar then meets us actually at paed A+E and takes us straight through to the ward if necessary, gives nebs in A+E if not.

It works well and was put in place by one of DS many consultants with input from the +E nurse (who is actually bvery helpful, and much much more use than most of dast and works very closely with the paed respitory consutlant

2.5 hours to get on a neb is to long. Ds is nomally on the neb in 10 mins of arriving in a and e.

I have found having a consultant makes things much easier as they are more understanding of toddlers with asthma than most gps are.

Okay, just spoke to a receptionist at the GPs and said I am looking to make an appointment in order to talk about a referral, and would I need to talk to a DR or the asthma nurse, the receptionist told me that the nurse doesn't make referrals but that I should see the nurse anyway, as she deals with all the asthma patients. She basically implied I wouldn't be getting a referal. This is the receptionist by the way.

So what should I do now- go to the appointment with the nurse, or make an appointment to see a GP?

I am so sick of pushing, she also has exzema and requires prescribed milk and I had to stamp my feet just to get that two years ago, then some more to get allergy testing (eventually we went private).

Or am I being over dramatic? Lime someone said, surely a wait of over two hours is a lol for a neb, she obviously needed it otherwise they wouldn't of given it to her.

Or do you think we will not get a referal because it isn't an every day problem? I worked it out that are averaging a hospital every three months or so.

Thanks again

Ds was reffered whilst an inpatient thankfully or we would have never got the gp to agree to refer us. I don't think they can refuse a second opinion though so if your not happy keep pushing.

Personally, if your asthma nurse is anything like mine I would go with her rather than the GP. But that may be because my asthma nurse can refer, prescribe meds and is generally an angel.

Do you know who the consultant you want to be referred to is. Has there ever been a consutlant in the hospital with you? Do you know the name of the consultant who said you should get open access. If you know that you can sometimes find a way round with their secretary too once you have been in hopstial by telling her that the consultant recommended it on your last admission.

Keep pushing.

I would demand a referral to a consultant. Ds has direct access to our children's unit (not asthma related) but they said it had to come from his consultant.

Dd1 had several asthma attacks (although not as severe as the ones you describe), and we were sick of being passed around various drs within the surgery, so we asked to be seen by a paed, and a referral was made - it made her care a lot more consistent.

I hope you get something sorted, be polite and firm, good luck.

I would just make an appointment to see your gp you don't have to discuss it with the receptionist. If they ask you just, say you don't want to discuss it.

I do not think you are being over dramatic, you need to know that you can help your child when they have trouble breathing, it can be very serious (obv.).

Ask the gp for a referral and if they don't give you one make an appointment with another dr at your practice and try again.

I hope you get this sorted out soon, it makes such a difference to quality of life when asthma symptoms are under control.

We have direct access fir ds1 but still have to go to A&E first incase ds needs emergency treatment then gets taken to the ward once stable x x
We are lucky that ds was under a consultant from 9 months and when ds2 was born he was seen as soon as he started having difficulties and has been on inhalers since 6 months x x we also have a home nebuliser but that is for ds1 x x

Thankyou.

Obviously going to A&E isn't really a problem, it's the fact that we have to go through triage, fill out forms, wait for Dr to see her etc.

Obviously it would be a much better solution if I had a number to call, and maybe someone could discuss her sats with me or something and then work out whether she should come in.

Oh, I don't know what I need- I just know that having to go via A&E procedures, repeat details over and over again, repeat history etc is a pain

I feel like she should be "known" and have her notes ready on arrival, IYSWIM?

Anyway, will see the nurse next week.
I know you guys said that you like your nurses, but I can't seem to get on with mine. She seemed to have this idea that I wasn't taking it seriously, and told me how often children die from asthma, and how important it was I give her the inhalers when she needs them??

All this after I have been dealing with it alone for two years, and repeatedly asking for help. I was told she wouldn't be diagnosed until she was 5, and then when the GP and nurse actually witnessed it, I get a DX and am told how serious it is?!

Sorry ranting now!

TheSecondComing- things don't seem very consistent do they.

My MIL works in health care and managed to get us a portable sats monitor, so that is helpful in figuring out where we are.

Let's hope I have been too harsh with our asthma nurse and she will be ultra helpful next week!

Make sure your care plan is written down, especially when she starts nursery/childminder/school

Altinkum- I'm not after having a nebuliser at home. She can get very bad, very quick, so am happy to be in hospital if she needs it.

I just think, reading on here, how many people have been refered and have a direct pass, and how much and often this affects DD, we also need some more support and guidance.

Hopefully that is what we will get when I see the nurse next week.

I am petrified of wasting time in A&E repeating history ect as nobody seems to take me seriously until they do her sats and realise her O2 levels are under 86%.

They should do her sats as soon as you arrive anyway.

Never worry about taking them to a and e if your worried about their breathing. They would rather seem them and them be fine than not see them and a problem get worse