Rheumatology at the Interface The Staffordshire Rheumatology Centre at the Haywood Hospital, Stoke on Trent

30/05/07 : By Dr S Ryan, Nurse Consultant, Rheumatology and Dr P T Dawes, Consultant Rheumatologist

		The rheumatology centre was established in the early 1970's and covers a population of over 500,000 people. The Haywood is a community hospital that specialises in chronic disease management. It is based within a Primary Care Trust although the consultant staff are employed within the acute hospital trust and are part of the Locomotor Directorate with Orthopaedics.

On the Haywood site there are dedicated inpatient, day case and outpatient facilities as well as access to physiotherapy, hydrotherapy, DEXA scanner, routine radiological and ultrasound imaging, occupational therapy, pharmacy and podiatry. In the evenings local patient groups including Arthritis Care, Back Care and the National Ankylosing Spondylitis Society use the hospital facilities engaging in self management

The Haywood Hospital

The department runs specialist condition based clinics for patients with early synovitis, rheumatoid arthritis, connective tissue disorders, sero-negative conditions, research, juvenile arthritis, osteoporosis, biologic therapy, and chronic musculoskeletal pain. This ensures that clinicians develop expertise in specific areas whilst enabling patients to be reviewed by the same team of clinicians. There are also combined clinics with a range of orthopaedic surgeons (spinal, hip, knee, shoulder and elbow, hands, feet), respiratory, renal and psychiatry. Consequently patients can be seen by a member of the rheumatology team whilst having the input from another speciality eg a patient whose knee has been affected by rheumatoid arthritis being reviewed by the knee surgeon and perioperative care being planned, or a patient whose mood is low having access to specialist advice from a liaison psychiatrist.

As there are over 4,000 patients on disease modifying drugs, drug monitor clinics run by a team of nurses occur on a daily basis and there is an evening clinic for patients in employment. The monitor clinics are supported by a computerised decision making programme which also contains all the clinic letters so team members can have access to the treatment plan and are able to access medical input when appropriate. The nursing community team conduct monitoring clinics in local hospitals and GP surgeries.

Some of the Rheumatology Team There are other nurse-led clinics, whose functions include supporting and educating newly diagnosed patients, a coping clinic focusing on the psychological and social impact of arthritis, on-going management of patients on biologic treatments, drug counselling and teaching patients how to administer sub-cutaneous medications. The department has a long established telephone advice service, which is primarily accessed when patients encounter problems with their medication or experience an increase in their arthritis symptoms and urgent/SOS appointments can be made when appropriate.

A very important aspect of our service is the Patient Panel. One of their aspirations is to have an education room where all patients can access relevant, current information to help them manage the symptoms.

Close working with the Orthopaedic team has resulted in development of STABS (Stoke Musculoskeletal Acute Backpain Service) and SMASHERS (Stoke Musculoskeletal Acute Slot Hospital Early Referral Service) that were developed to tackle long outpatient wait times. They have evolved over the last 10 years to become an established musculoskeletal interface service based in primary care and involves Consultant Rheumatologists and Rehabilitationists, GPs, Consultants and Extended Scope Therapists. These services allow quicker and appropriate access for patients to both Rheumatology, Pain and Orthopaedic services. They include a number of common agreed processes including care pathways and clinical algorithms. These services continue to evolve with implementation of the NHS reforms. We face this challenge by maintaining an ethos of 'joined up' continuity of care for patients with arthritis. This is facilitated by having a first rate Hospital Manager who works closely with clinicians and patients.

We are very fortunate in having an established active charity (HRRDF) that has been instrumental in pump priming clinical services, eg DEXA scanner, supporting educational and research activities. Along with external grant funding, it supports an active research team of laboratory scientists, medical staff and research nurses. The research programme includes clinical trials of new therapies, understanding disease outcome and pathogenesis eg the detrimental effect of smoking on RA. Development of the Keele Medical School has enabled the department to work closely with both undergraduate and postgraduate educational activities along with a developing liaison with Primary Care Research. The department has also been active in developing educational opportunities for doctors, nurses and allied health professionals and runs the only MSc in clinical rheumatology nursing.

The effect of having an active research and educational programme is an essential stimulation to the development and delivery of services.

Despite the challenges of an ever changing NHS, the ethos of the department is one of a team spirit, working across professions and organisational boundaries, to provide a quality, friendly, holistic service for patients.