Background: Traditionally, rheumatology referral prioritisation depended solely on information contained in referral letters. Often, referrals lacked sufficient information to enable a decision about disease activity. This led to patients not being seen within appropriate timeframes, reduced clinic efficiency and reduced capacity. A standardised system of prioritisation called Advanced Clinical Prioritisation (ACP) was introduced for the Inflammatory Arthritis (IA) Waiting Lists (WL).

Objectives: To align patients with the most appropriate care pathway thus increasing clinic efficiency and optimising capacity for specialist services versus traditional methods of prioritisation.

Methods: A standardised assessment proforma was designed, containing recognised symptoms of IA. Clinical Specialist Physiotherapists (CSP) contacted all patients referred to IA clinics between November 2022 and November 2023 in a virtual clinic setting to complete this ACP assessment. High-scoring patients were fast-tracked to a consultant-led clinic. Lower-scoring patients were directed to a CSP-led clinic with consultant support.

Results: A total of 414 phone calls were made to 364 patients. 61% (n=221) patients were deemed appropriate for the Consultant-led IA clinic, (n=151 from the urgent, n=70 from the soon WL). Additionally, 28% (n=102; 57 from the urgent, 45 from the soon WL) were directed to the CSP clinic and 11% (n=41; 29 from the urgent, 12 from the soon WL) were discharged directly from the ACP clinic (Figure 1). Of the 196 patients booked in the Consultant-led IA clinic in this timeframe, 52% (n=102) were diagnosed with an IA (Figure 2). 40% (n=78) did not have an IA diagnoses, with a Did Not Attend (DNA) rate of 8% (n=16). In the CSP-led clinic a total of 72 patients were booked. Of this cohort 18% (n=12) were diagnosed with IA, 82% (n=54) did not have an inflammatory diagnosis. There was a 9% (n=6) DNA rate. Had the traditional prioritisation system of urgent and soon been used, this method would have gleaned 43% (n=83) IA diagnoses from the urgent WL, and 32% (n=31) from the soon WL.

Conclusion: Utilising an ACP method to streamline referrals for IA to appropriate clinics is an effective method, providing a standardised pathway of care by aligning patients with the most appropriate clinic.

REFERENCES: NIL.

Figure 1.

Figure 2.

Acknowledgements: NIL.

Disclosure of Interests: None declared.