Background Rheumatology is largely an outpatient specialty. Changes in healthcare structure in recent years have seen a trend for increased demand for specialty input in acute inpatient care. However, financial pressures on the other hand have led to calls to curtail specialty on-call service. Service provision apart, “being on-call” has traditionally been seen as an important educational experience, equipping registrars with valuable acute rheumatology skills. Despite all these, there is little published literature evaluating the contribution and workload of Rheumatology on-call service.
Objectives This study sought to evaluate the contribution of Rheumatology on-call service as well as to assess the spectrum of conditions referred.
Methods An electronic database was created to record details of on-call referrals received by one Rheumatology specialty registrar in a tertiary hospital. These included relevant clinical details, outcomes of referral and working diagnosis.
Results A total of 40 referrals were recorded over 9 days in a 5-week period from December 2016 to January 2017. Seventeen referrals were reviewed on the same day by the rheumatology registrar. Referrals from medical wards comprised 10 out of 17 referrals reviewed. Other sources of referrals were Emergency Department, General Practitioners and Rheumatology advice phone line with 4, 2 and 1 referrals respectively.
Of the 17 patients reviewed on-call, 11 referrals (65%) could be classified in the category of “acute hot joint”, 2 were in the category of vasculitis and connective tissue disorders, 2 were predominantly mechanical problems, 1 was referred with a painful limb while 1 had an elevated creatine kinase. Thirteen of these 17 patients required an arthrocentesis, 12 of which were either performed or supervised by the rheumatology team. Septic arthritis was diagnosed in only one patient. Three of the 17 patients had musculoskeletal ultrasound scan performed by the rheumatology team on the same day.
Conclusions Rheumatology on-call service provides a significant contribution to acute care which cannot be substituted by other specialties. It also continues to provide rheumatology trainees with experience in acute rheumatology although it could be argued that the spread of conditions seen were skewed toward acute hot joints and that exposure to connective tissue disorders and vasculitis was limited. The results of this study have important implications for planning and delivery of postgraduate Rheumatology training curriculum and delivery of on-call Rheumatology service.
Disclosure of Interest None declared