CAN A SPECIALIST NURSE REPLACE A CONSULTANT - AN INNOVATIVE MODEL FOR OSTEOPOROSIS CARE
1Luton and Dunstable University Hospital, Luton, United Kingdom
Background: Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. However this can significantly delay treatment pathway owing to lack of sufficient consultant appointments. Clinical nurse specialists (CNSs) are an integral part of a multidisciplinary team employed to provide effective care for the diverse needs of patients with chronic conditions such as osteoporosis.
Objectives: We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver a high-quality and safe service.
Methods: A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. Using the database, we compared the timelines for patient journey to conventional pathway, obtained the number of consultant follow-up appointments saved by implementing this service and calculated total savings.
Results: In the proof-of-concept phase, 60 patients were triaged into the new service. It was a combination of 25 new referrals and 35 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 19 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. Sixty new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days.
Conclusion: To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions.
Disclosure of Interests: Julie Begum: None declared, Joanne Fourmy: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB
, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB
, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB
Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 1279
Session: HPR Service developments, innovation and economics in healthcare