P009 Improving axial spondyloarthritis time to diagnosis: a quality improvement project
Authors: Voules Sue , Kelly Cheryl , Alcala May , Premraj Sarah , Gudu Tania 
Published: April 2024

Background/Aims

The average UK time to diagnosis for axial spondyloarthritis (axSpA) remains unacceptably long, i.e., 8.3 years, with high economic costs and impact on patients' outcomes. Until October 2021, the Rheumatology department at Ipswich Hospital did not have an axSpA service, no specific referral pathways, no dedicated clinics, and no standardized patient journey. The main objective was to develop an axSpA service from scratch and to raise awareness on axSpA amongst health professionals. A more specific quantifiable objective was to reduce the time from patient presentation in primary and secondary care to axSpA diagnosis in rheumatology.

Methods

For the first year since service inception (November 2021 to February 2022), we have set up the ambitious aim of developing an axSpA service, focusing on designing a referral pathway, on establishing connections with primary and secondary care, and on providing education on axSpA. To evaluate improvement in time from patient presentation in primary/ secondary care to axSpA diagnosis, we have audited all new suspected axSpA cases in the first three months of service inception (November 2021 - February 2022) and compared data from the same period of time, a year later (October 2022 - February 2023). The Plan-Do-Study-Act (PDSA) methodology was used. The quality improvement project is part of Aspiring to Excellence programme (endorsed by National Axial Spondyloarthritis Society/NASS).

Results

Our axSpA service was established in November 2021. We initially established connections with primary and secondary care. Within a year, we have developed an axSpA referral pathway for primary care which was designed to reflect NICE guidelines. All suspected axSpA referrals were triaged in rheumatology as urgent rather than routine and booked into a dedicated axSpA clinic running once weekly. All patients benefited from a specialized physiotherapy review. Formal and informal referral patwhays were also developed with secondary care. Additionally, we have established monthly multidisciplinary team meetings with dermatology, ophthalmology, spinal team, as well as community physiotherapy. Regular education sessions were delivered to primary care. A specific radiology- MRI pathway was also established. The audit on time until diagnosis included a total of 94 patients with suspected axSpA. The waiting time from initial presentation in primary/ secondary care to rheumatology first appointment decreased from a median of 17 weeks to 5 weeks; the time from first rheumatology appointment to diagnosis decreased from 17 weeks to 7 weeks. Overall, patients with axSpA had to wait a median of 13 weeks from initial presentation to diagnosis in rheumatology versus 29 weeks at service inception.

Conclusion

In only a year, we have established an axSpA service de novo with clear and standardized pathways. There was a significant improvement in waiting times for patients waiting to be referred and diagnosed with axSpA.

Disclosure

S. Voules: None. C. Kelly: None. M. Alcala: None. S. Premraj: None. T. Gudu: None.