Background Rheumatology Ambulatory Care Unit (RACU) pilot was carried out in James Cook University Hospital from January 2013 to March 2013 to provide systematic acute rheumatological care to patients soon after the referral.
Objectives The objectives were to improve access of patients to the rheumatology service and provide facility for managing elective patients in an ambulatory setting as opposed to the ward.
Methods A seven week pilot was carried out, which operated from Monday to Friday. Referrals were taken by either the nurse or the consultant from GPs, A&E, medical and surgical specialties and patients calling the Rheumatology advice line directly. They were then triaged into RACU and seen in the afternoons. Patients were seen by the nurse on arrival; initial assessments were done by the junior doctor and thereafter seen by the consultant for a definitive plan
Results 112 patients were seen over a 7 week period, averaging 3.2 patients per day. Age range was between 23 to 84 years. 76 were females and 36 males.
51% patients were seen either the same or the next day (27.7% and 23.7% respectively). 8 out of 9 new referrals were diagnosed with an Inflammatory Arthritis (IA), most of them being Rheumatoid Arthritis (RA). 49 patients were seen for a flare of their IA. 10 new and 1 follow up patient were reviewed urgently for a suspected Giant Cell Arthritis (GCA). 13 patients were seen with an acute hot swollen joint. Several other conditions were diagnosed or dealt with e.g. osteomyelitis, metastatic vertebral collapse, Sarcoidosis, amyloidosis, insufficiency fractures, Wegener's Granulomatosis and Dermatomyositis. 22 patients received one or more intra-articular injection. 18 received one or more intramuscular or intravenous (IV) corticosteroid injection. Imaging was arranged for 18 patients and medications were changed or added in 17 patients which included change in biologic or non-biologic drugs for IA, epoprostenol and IV Bisphosphonates
7 patients were admitted, one patient each for osteomyelitis, probable septic arthritis, Vasculitis and ischaemic finger, severe Primary Raynaud's and ischaemic foot, spinal pain and immobility and two for severe RA. 28 patients may have been admitted to hospital if RACU was not available.
Estimating the length of stay, a total of 101 bed days were saved, averaging 2.06 beds per day. These beds may have been saved from other specialties as well. Most bed days saved were from presentations of severe back pain, IA and sight-threatening GCA
Patient satisfaction questionnaires were posted after the trial period of RACU. 49% of the forms were returned back. This showed that 73% were seen by a doctor within 30 minutes. 90% were satisfied that they had been explained everything about the care they were receiving. 94% showed satisfaction with the service they received.
Moreover, it provided with a useful learning opportunity which was greatly appreciated by the junior medical staff.
Conclusions Our results show that RACU can reduce inpatient admissions and provide prompt diagnosis and treatment for patients with acute presentations; thus, depicting efficient and streamlined system for the care of patients.
Disclosure of Interest : None declared