Spotlight on a Rheumatology Unit - Rheumatology Adult Service Belfast Health and Social Care Trust

05/09/08 : By Elaine Wylie, Rheumatology Nurse Specialist and NRAS Nurse Advisor for Northern Ireland

Introduction

The Rheumatology Adult Service in the Belfast Health and Social Care Trust is situated over 3 hospital sites. Musgrave Park houses a 30 bedded inpatient unit along with the 21 bedded Day case / Biologic Unit. The outpatient services are in the two large acute hospitals in central Belfast, the Belfast City Hospital and Royal Victoria Hospital. Locally we serve a population of 340,000 but we do accept referrals from outside our local catchment area.

                                

Meet the Team		Rheumatology in Belfast takes pride in its teamwork, working closely across the three sites. The patients and their families are always the centre of our care and team. We have 7 Consultant Rheumatologists (Dr Aubrey Bell, Dr Andrew Cairns, Prof Michael Finch, Dr Clare Matthews, Dr Adrian Pendleton, Dr Allister Taggart and Dr Gary Wright), 2 Staff Grades (Dr Maura McCarton and Dr Maria Wray), 5 Registrars, junior doctors rotating though the speciality, specialist physiotherapists, occupational therapists, pharmacists, social workers, podiatry and clerical staff.

There is a large team of nursing personnel working in the inpatient unit, day case/ biologics and outpatients as well as 2 Rheumatology Nurse Specialists (Anne Quinn and Elaine Wylie). We also work closely with the voluntary groups in NI who provide literature, information days and valuable one to one support.

Services Provided

The unit provides a variety of specialist outpatient clinics including early arthritis which provides rapid access for expert assessment, diagnosis and management of patients with new onset symptoms of inflammatory arthritis eg rheumatoid arthritis. The connective tissue diseases clinic looks after patients with conditions such as lupus. There is an osteoporosis clinic where patients are referred following fractures along side those with risk factors for the condition. Annual review clinics have been established to reflect holistic patient care as well as screening for cardiovascular and osteoporosis risk. The majority of clinics are for general rheumatology and joint injection.

Our unit has strong links with community teams. We have well established regional shared care guidelines and protocols for the prescribing and safety monitoring of disease modifying anti-rheumatic drugs. 

Biologics Unit

The biologics unit is very busy as we currently have 634 patients on these treatments. The day to day running of this service is managed by 2 staff grade doctors and a team of nurses over seen by the consultants. The unit is patient focused and delivers high quality, efficient care. Patients are assessed using NICE guidelines, educated with regard to their specific medication, started on treatment and regularly reviewed for response and side effects. Intravenous therapies ie infliximab and rituximab are administered in the unit. All patients are registered with the BSR Biologics Registry and we also recruit patients for the control study.

Day Ward

Within the day ward each consultant team has a dedicated session. Patients attend to receive more complex treatments for conditions such as raynauds and pulmonary hypertension. They may also attend for follow up and ongoing investigation.

		Ultrasound A recent development has been the use of musculoskeletal ultrasound in the unit. Senior medical staff use sonography to assist with diagnosis and management of patients. We are very fortunate to have access to this facility both in the inpatient unit and in outpatients where portable machines are available. The unit has established itself as one of excellence in this area and has run a national BSR training course for Rheumatologists and has also completed in-house courses. Along side this we are privileged to have access to high standard musculoskeletal radiology.
Dr Cairns completing ultrasound on a patient’s hand

Outreach Clinics

A number of years ago the opportunity arose to develop rheumatology services in 2 district general hospitals. The first pilot started in the Downe Hospital, Downpatrick with a consultant and specialist nurse running a clinic once a month. An audit of this service showed a high level of GP and patient satisfaction. As a result of this, the frequency of the clinic increased with the addition of further specialist team members. A similar service has evolved in the Lagan Valley Hospital, Lisburn.

Rheumatology Nurse Specialist Services

There are 2 rheumatology nurse specialists (RNS) who run nurse led clinics including patient education, psychosocial support, assessment of disease activity, monitoring of therapy and screening. Both RNS have busy helpline services allowing direct access to expert advice for patients and families. Recently there has been the development of clinics to facilitate patients to self-administer subcutaneous methotrexate. Anne Quinn, Rheumatology Nurse Specialist manning the telephone helpline

Specialist Allied Health Professional (AHP) Services

At each of the 3 sites there are designated specialist AHP teams. Patients are routinely referred to the team to ensure holistic care and independent living. The Musgrave Park site has a new physiotherapy department with a large pool for hydrotherapy and gym equipment.

Research

The unit actively participates in a variety of research and audit. Areas include early inflammatory arthritis, patient education, ultrasound, lupus, osteoarthritis, crystal arthropathies and osteoporosis.

Summary

The majority of patients referred to our service require long term management and it is very important that they have access to the appropriate treatments and personnel at the correct time and in the most convenient environment. Patients who are knowledgeable about their condition and confident about their care have better long term outcomes. As a team, we work hard to achieve these goals.