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AB1111 Specialized Rheumatologic Assessment in an Accident and Emergency Enviroment: One Year Experience of the Urmes Initiative
  1. C.A. Guillen Astete,
  2. F.J. Bachiller-Corral,
  3. A.L. Boteanu,
  4. M.A. Blázquez Cañamero
  5. on behalf of URMES
  1. Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain

Abstract

Background The specialized rheumatologic assessment of patients who demand urgent attention in our A&E department is conducted by three rheumatologists since October 2013. Its official designation is Clinic of urgency rheumatologic and musculoskeletal consultation (URMES by its initials in Spanish). There is no clinic or unit with this characteristics in Madrid and as far as we know, neither in Spain. Rheumatologists assess patients according to their main complaint, with the exception of those related to direct or indirect trauma, into a specific office located inside the A&E area of our institution, a high complexity university hospital. Also it gives support to any other clinician who considers necessary a rheumatology assessment for any specific patient. URMES counts with an office, a portable ultrasonographic unit and material required to perform joint punctures. Also, URMES have access to lab and radiological auxiliary tests with the same priority of any other A&E instances.

Objectives To describe the gathered experience along the first year of the URMES.

Methods Observational study. Source: Electronic attending registries of the A&E department, records of teaching activities and scientific production from 2013 to 2014

Results 1788 patients were assessed along the period of observation. 1490 (83.3%) of them were assessed in the morning and 298 (16.7%) in afternoons or night (out of the regular URMES schedules). 56.3% of patients were female. Average age was 67.3 SD 7.3 years. 85.6% of patients proceeded from our Hospital healthcare area. 1022 patients consulted spontaneously (57.2%) while 294 were derived from their General Practitioner (16.4%), 69 were re-assessed by instruction of the rheumatologist (3.9%), 69 were instructed to came to the A&E a day with URMES consult scheduled (3.9%) and finally 45 patients consulted spontaneously demanding a new assessment due to a worsening of their condition after been assessed by URMES, previously. 435 patients consulted by complaints related to the knee (24.3%), 362 related to the axis skeleton (20.3%) and 336 related to the shoulder (18.8%). 1155 patients were diagnosed by mechanical issues (p.e. osteoarthritis) (64.6%) and 633 were diagnosed by inflammatory conditions (35.4%). In this last group, distribution of diagnostics was: autoimmune 18.2%, septic 39.2% and microcrystalline 42.7%. 390 joint punctures with injection of corticoids, 292 joint aspirations and 381 ultrasonographic studies were performed. URMES developed 9 lectures to residents and faculties with 110 hours which were attended by 366 students. During these two years the scientific production of URMES was: 54 congress communications and 14 journal papers.

Conclusions There are no previous experiences with a specialized rheumatology clinic into the A&E so it is not possible to establish comparisons. We consider that a better positioning of our specialty highly depends on how closer become the rheumatologist to the community and the response we could provide to the urgent needs of patients or other clinicians. In this way, we are convinced that the URMES initiative has an important role and its instauration in many other A&E should be considered.

Disclosure of Interest None declared

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