ABSTRACT
Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.
ABSTRACT
Background/Aims Quality improvement (QI) is now an expected part of healthcare professional practice. After identifying a gap in available training and successfully delivering a QI course for 35 clinicians at the Northwest Rheumatology Club, trainee representatives were invited by the BSR invited to convene a national workshop. Methods The first BSR Quality Improvement Practical Methodology Workshop was held in March 2021 (online, due to COVID-19). Materials were adapted from the well-established Trainees Improving Patient Safety through Quality Improvement (TIPSQI) initiative. Plenaries covered the Model for Improvement, process mapping, SMART aims, driver diagrams, stakeholder engagement, illustrated using rheumatology-specific case-studies. Delegates (with mixed experience / professional role) practiced using tools in small, facilitated, breakout rooms. Pre-course surveys informed course design. Post-course and six-month follow up surveys evaluated impact. Because there are no validated tools to evaluate the impact of QI training, Kirkpatrick’s four-step hierarchical model, commonly used in this context, was employed. Results Of 30 delegates (consultants, trainees, pharmacists, nurses, physiotherapists), 28, 22 and 4 completed pre-course, post-course and six-month surveys, respectively (Table 1). For Kirkpatrick level 1, ‘reaction’, all respondents were ‘satisfied’, with 100% recommending to colleagues. Using driver diagrams as an exemplar to evaluate level 2, ‘learning’, pre-course, delegates were: not aware 16/28(57.1%), aware 9/28(32.1%), confident to use 3/28(10.1%), 0/29(0%) confident to teach. Post-course improvements showed confidence to use 22/22(100%), and teach 12/22(54.6%) (maintained at six months). Given low numbers of six-month respondents, assessing long-term impact is challenging. Evaluating level 3, ‘behaviour’, all 4/4(100%) respondents conducted QI post-course, with 2/4(50%) teaching. Delegates reported that the course gave confidence to use tools and support others. In evaluating level 4, ‘results’, 1/4(25%) felt the course had changed the impact of their work, with 3/4(75%) reporting time and institutional constraints as barriers to conducting QI. P079 Table 1 Pre-course, post-course, and six-month survey resultsTopic / questionPre-course N = 28Post-course N = 22Six-month N = 4KIRKPATRICK LEVEL ONE: REACTIONWould you recommend this course to a colleague?-Yes: 22/22 (100%)-Please indicate your overall satisfaction with the course? 1 - not at all satisfied, 5 - very satisfied-4 points: 11/22 (50%) 5 points: 11/22 (50%)-KIRKPATRICK LEVEL TWO: LEARNINGDriver diagramsDo you know what a driver diagram is? No: 16/28 (57.1%) Yes, aware of: 9/28 (32.1%) Yes, confident to use: 3/28 (10.1%) Yes, can teach: 0Do you feel confident to use a driver diagram? 22/22 (100%) Do you feel confident to teach someone to use a driver diagram? 12/22 (54.6%)Do you feel confident to use a driver diagram: 4/4 (100%) Do you feel confident to teach someone to use a driver diagram? 2/4 (50%)Process mappingDo you know what process mapping is? No: 9/28 (32.1%) Yes, aware of: 13/28 (46.5%) Yes, confident to use: 7/28 (25%) Yes, can teach: 0Do you feel confident to process map? 22/22 (100%) Do you feel confident to teach someone to process map? 10/22 (47.6%)Do you feel confident to process map? 3 (75%) Do you feel confident to teach someone to process map? 0PDSA (plan-do-study-act) cyclesDo you know what a PDSA cycle is? No: 5/28 (18%) Yes, aware of: 13/28 (46.1%) Yes, confident to use: 9/28 (32.1%) Yes, can teach: 1/28 (3.6%)Do you feel confident to carry out a PDSA cycle? 22/22 (100%) Do you feel confident to teach someone to carry out a PDSA cycle? 12/22 (54.6%)Do you feel confident to carry out a PDSA cycle? 3/4 (75%) Do you feel confident to teach someone to carry out a PDSA cycle? 3/4 (75%)How confident are you at contributing to a QI project? 1 - not at all confident, 5 - extremely confidentMean 2.3 Median 2 Range 1-4Mean 4.36 Median 4 Range 1-3Mean 4.5 Median .5 Range 4-5How confident are you at leading a QI project? 1 - not at all confident, 5- extremely confidentMean 3.36 Median 3 Range 1-5Mean 3.95 Median 4 Range 3-5Mean 4 5 Median 4 Range 3-5How confident do you feel in engaging patients in projects? 1 - not at all confident, 5 - extremely confidentMean 3.07 Median 3 Range 1-5Mean 3.72 Median = 4 Range 3-5Mean 3.75 Median 4 Range 2-5KIRKPATRICK LEVEL THREE: BEHAVIOURWill you change your way of practicing as a result of the course?-Yes: 22/22 (100%)-Have you done any QI work since the course? If so, how did the course influence that?--Yes: 4/4 (100%) Confidence to use toolsHave you taught or supervised anyone in QI since doing the course? If so, how did the course influence that?--Yes: 2/4 (50%) Provided a structure to support others doing QIKIRKPATRICK LEVEL FOUR: RESULTSHas attending the QI course changed the impact of your QI projects? If so, please explain how?--Yes: 1/4 (25%) No: 3/4 (75%) Provided more structureHave you experienced any barriers to conducting QI in the way that you would like to?--Yes: 3/4 (75%) No: 1/4 (25%) Time and institutional supportTestimonials“I think it was an excellent course for those starting on QI projects. It gives a structured direction to the project” “Fantastic course to equip you with the tools and confidence to launch yourself into the world of QI. Just the right balance of theory and practical workshops.” “I have always [been] interested in QI. This course has definitely enthused me further in contributing and leading QI, with better understanding in applying QI tools. Thank you!” Conclusion The QI course has been commissioned as a BSR annual ‘core educational’ offering, with feedback showing it was needed, wanted, and effective in delivering core QI principles. In response to six-month feedback, additional post-course-support is planned in future, aiming to capacity build expertise in QI and embed a sustainable culture of improvement across the rheumatology community. Disclosure C.A. Sharp: None. R. Benson: None. H. Baird: None. E. MacPhie: Other;EM is the North West Rheumatology Club secretary and meetings have been sponsored by MSD, UCB, Abbvie and Lilly.
ABSTRACT
Background/Aims The National Early Inflammatory Arthritis Audit (NEIAA) has provided the opportunity for rheumatology services to benchmark the care they provide against NICE quality standards (QS)33. It has proven to be a powerful lever for improving quality and our department is testimony to this. Recruitment to all national audits was paused for several months due to the COVID-19 pandemic. Once pressures had eased we recognised that NEIAA would help to understand the impact of the pandemic on the diagnosis and initial management of patients with rheumatoid arthritis. Our department continued to see all new urgent referrals face-to-face and were fortunate that the team were not redeployed. Methods Data submitted to the NEIAA online tool during year 3 (September 2020-March 2021) were downloaded for analysis. Data from year 2 were downloaded for comparison. Results In year 3, 154 patients were recruited to the audit compared to 268 in year 2. 36 (23%) had rheumatoid arthritis and were included in the follow-up cohort compared to 73 (27%) in year 2. All patients had a baseline and a 3-month follow up form completed, however 17 patients in year 3 had a telephone appointment at 3 months and there was no available DAS28. Patient demographics were similar. The case mix of patients recruited was also;in year 3, 41% were diagnosed with autoimmune inflammatory arthritis compared to 47% in year 2 and 42% with a non-inflammatory condition compared to 39% in year 2. In year 3, 41% of all patients were seen within 3 weeks of being referred and 58% of patients with RA started DMARD therapy within 6 weeks of referral. This compared to 54% and 56%, respectively, in year 2. In year 3, symptom duration prior to referral appeared longer: 31% had symptoms for less than 3 months, 31% for 3-6 months, 22% for 6-12 months and 16% for more than 12 months compared to 67%, 18%, 12% and 3%, respectively, in year 2. DAS28 at baseline was higher in year 3 with 47% high, 47% moderate and 6% low disease activity or in remission compared to 27%, 61% and 12%, respectively, in year 2. DAS28 at 3-months was also higher in year 3 with 16% high, 37% moderate and 27% low disease activity or remission compared to 6%, 25% and 69% respectively in year 2. Conclusion Despite the impact of the pandemic we have maintained our performance against QS2 and 3. However, patients seemed to have longer duration of symptoms prior to referral, higher disease activity at baseline and at 3 months. We await the 12-month data to determine 1-year outcomes, including escalation to high cost drug therapies. Disclosure E. MacPhie: Other;EM is the secretary of the North West Rheumatology Club, meetings have been supported by UCB, MSD, Abbvie and Lilly. L. Ashcroft: None. N. Foreman: None. S. GIlbert: None. S. Horton: None. A. Madan: None. K. Moon: None. C. Rao: None. S. Fish: None.
ABSTRACT
Patients with rheumatic diseases face serious shortages of vital medicines
ABSTRACT
Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.