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Rheumatology (United Kingdom) ; 61(SUPPL 1):i58-i59, 2022.
Article in English | EMBASE | ID: covidwho-1868389


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 rheumatologyspecific case-studies. Delegates (with mixed experience / professional role) practiced using tools in small, facilitated, breakout rooms. Precourse 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. 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.

Rheumatology (United Kingdom) ; 61(SUPPL 1):i34, 2022.
Article in English | EMBASE | ID: covidwho-1868364


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.

Rheumatology (United Kingdom) ; 60(SUPPL 1):i22, 2021.
Article in English | EMBASE | ID: covidwho-1266146


Background/AimsIn 2017 an audit and survey of giant-cell arteritis (GCA) services wereconducted across northwest England (reported previously). This resurvey in 2020, following publication of revised BSR guidance, soughtto identify what changes were made in the intervening period, andprovided the opportunity to assess the impact of COVID-19.MethodsRheumatologists from 16 hospitals in northwest England were invitedto complete a survey in July 2020. Questions focused on serviceprovision for GCA, including pathways, diagnostics and steroidprescription.ResultsResponses were received from 14/16 sites in 2017, and 15/16 in 2020.9/15 (60%) sites reported that the 2017 audit and survey promptedchanges to GCA services, with two (13%) stating that it clarified theneed for implementation of existing plans. Two sites had a GCApathway in 2017. Four of the seven sites who committed to introducingone have now done so, bringing the total in 2020 to six. Eight of thenine remaining sites plan to implement one, six with a specific datewithin six months. Six (40%) have completed additional local audit/QIsince 2017. Temporal artery (TA) ultrasound (US) is now available in anadditional four sites, bringing the total to 6/15 (40%) in 2020. Two sitesreported improvement in both time between first rheumatologyconsultation and TA biopsy, and time to receive results (now <7days for each task in 6/15 (40%)). Six additional sites reportedproviding leaflets on steroids routinely, bringing the total in 2020 to 12/15 (80%), versus 6/14 (43%) previously. Four sites (27%) now have adatabase of GCA patients (one in 2017). There was no major change insites having a standard protocol for steroid taper (n = 8 2017;n = 72020, 89% and 100% of whom respectively use BSR guidance), nor inthe number of patients routinely provided steroid cards (six in 2017;five in 2020). The three sites who do not report giving leaflets onsteroids routinely, all had a pathway. 8/15 (53%) reported COVID-19having an adverse effect upon services, including: reduced access todiagnostics (n = 7: TA US, biopsy, and PET-CT);delayed appointments(n = 4);delayed referrals (n = 3). The tertiary referral centre reported animprovement because access to tocilizumab was facilitated by arelaxation of rules by NHS England.ConclusionThe original audit and survey of current GCA practice in 2017highlighted areas for improvement for each site, and regionally. Sitescontributing to this re-survey report that the exercise stimulated themto improve their current care. The 2017 exercise showed a strongcorrelation between reported practice (survey) and actual practice(audit), leading us to have confidence that responses provided a truepicture of care. This work demonstrates the power of audit to driveimprovement, at a regional level.