Audit of the Rheumatology Day Case Unit

01/06/04 : Clinical Effectiveness Department, NHS Grampian

Introduction

The Rheumatology Day Case Unit (DCU) operates on a Monday to Friday basis between the hours of 9am and 4pm and is situated within ward 3 at Aberdeen Royal Infirmary. The DCU was set up in October 2002 to adequately accommodate the increasing number of day case patients that the department was receiving. This increase was partly due to increased funding for Biologic Therapies, Infliximab and Etanercept, which treat Rheumatological diseases such as Rheumatoid Arthritis, Ankylosing Spondylitis and Psoaritic Arthritis. The increase in number of day case patients was also partly due to the fact that some specialist infusions were now being administered as a day case procedure rather than requiring admission to the ward, in order to reduce in-patient bed utilisation.

The primary aims of this audit are to:-

• Ascertain patient satisfaction with the service currently provided within the Rheumatology DCU
• Evaluate the effectiveness of this service
• Utilise the baseline information derived from the audit findings to indicate any changes and further development of this service that might be necessary.

Method

All 56 patients who had visited the Day Case Unit between it’s opening in October 2002 and June 2003 were included in the audit and a questionnaire was sent out to these patients in July 2003. 41 (73%) questionnaires were returned.

Results (n=41)

• 76% of patients had two or more visits to the Unit
• 44% of patients commenced therapy, on average, within 30 minutes of arrival to the Unit
• 37% of patients were Biological patients
• 66% of patients felt that the opportunity to discuss their anxieties/problems was ‘always’ provided
• 91% of patients felt that their overall needs were met either ‘always’ or ‘most of the time’
• 58% of patients stated that they would prefer weekday infusions to weekend or evening infusions If patients had concerns regarding their treatment or care
• 28% of patients would contact a doctor,
• 23% of patients would contact their GP,
• 19% would contact the ward nurse and
• 13% would contact the Arthritis and Osteoporosis Resource Centre (AORC)
• 69% of patients had previously been an in-patient and 61% of these patients would prefer to be treated as a day case with another 32% having no preference
• 38% of patients stated that the main strength of the DCU was the reduced time spent in hospital

Conclusion

Preference for treatment in most cases appeared to be treatment as a day case. The need to develop flexible working times did not on this occasion apply. All patients identified a health professional as a point of contact should they have had any concerns regarding their care. However the specified personnel identified varied and perhaps it is necessary to consider in terms of equity and consistency whether patients should be given standard information on who to contact in different circumstances. On reflection, the primary aims of this audit have been met in that the evidence obtained from the results has enabled conclusions to be made about the effectiveness of the service. The results have also been utilised to facilitate discussion within the Rheumatology department as to how the service could be improved whilst recognising the already positive aspects of the existing service. Thirty-seven percent of patients were Biological patients but only 13% overall were aware to contact AORC for support and advice post infusion. This proved disappointing given that at the time of audit AORC followed up all Biologic Patients once they left the DCU via telephone. This has therefore highlighted a need to examine current communication channels and develop a separate helpline specific for Biologic patients to that offered more generally by AORC.

Action Plan

• Display audit findings in the Rheumatology department for patient interest and involvement, (30/06/04).
• Development and launching of a telephone helpline service, (31/10/04).
• Consider a leaflet for patients indicating who to contact determined on the concerns that the patient has, (30/07/04).
• Rearrangement of service delivery to prioritise/rationalise most efficient and effective delivery of patient care, (30/07/04)
• and re-audit, (31/10/04).