Emergency care patient driven solutions for severe asthma

Purpose Patients with severe asthma were choosing not to use the emergency department in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue was a reflection of a nationwide situation. The aim of this study was to better understand the reasons for this locally and consider practical solutions in a structured way with users of the service Methodology Systems thinking was used (soft systems methodology) to better understand the problem and examine possible solutions in co-production with people who live with severe asthma. Findings and Practical implications The problem was identified and fully revealed-patients felt vulnerable and fearful of the emergency department. This appeared to be a well-defined problem with possible solutions. Once this tame problem was revealed a possible solution was developed in co-production with patients. The solution was an Asthma Patient Passport (APP) which increased confidence in patient’s ability to communicate their needs in severe distress by facilitating communication of needs and decreased the work patients had to do to achieve care from twelve steps to five steps. The implementation of the APP is currently being evaluated. Value By revisiting systems thinking and identifying problems, a solution was possible. Although methods such as soft systems methodology have limitations when used to in wicked problems, such methods still appear to have merit in tame problems and could be used in these circumstances to fully understand problems and design practical solutions