64. Tertiary referral Autoimmune Inpatient Service: Multi-professional model of care addressing key milestones in patient care
Creators: name: Egan1, Allyson C.
name: Boon1, Cheng
name: Jayne1, David R.W.
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Purpose:</strong> The multi-disciplinary Vasculitis &amp; Lupusx Service at Addenbrooke’s Hospital Cambridge, is composed of the Outpatient Clinic Service, the Inpatient Autoimmune Service and the Academic and Education Section. Close liaison between the inpatient and outpatient services facilitates rapid access to consultation, therapies, admission and discharge for patients. The Autoimmune inpatient service has a designated on-call Consultant and Registrar, with a specialist interest in autoimmune disease, comprising of Nephrologists and Rheumatologists. On-call responsibilities include the direct management and consults service for inpatients with autoimmune disease and those in whom the diagnosis is suspected and require diagnostic input and expertise. <strong>Methods:</strong> The inpatient service was reviewed for 8 weeks with the aim to delineate the inpatient population, the reasons for admission, demographics, diagnosis, interventions, length of stay and weekly turnover. It sought to investigate key constituitive components inputting to the Inpatient Autoimmune service, to capture multi-organ specialist review and the workings of a multi-disciplinary service. <strong>Results:</strong> Regarding in-patients, 28 were under the direct care of the service during the 2-month study. The median age was 59 years (46-69), 19 (67.9%) were female and 9 (32.1) were male. The median length of stay was 6.5 days [IQR 5-12.75], the range was 2-43 days. For in-patients with a pre-existing diagnosis of autoimmune disease (n=18), this included vasculitis (n= 9, 50%), lupus (n=4, 22%), unconfirmed (n= 3, 16%) and rheumatoid arthritis (n= 1, 5.6%). The referral source for their admission was clinic (n=15, 53.6%), the emergency department (n=8, 28.6%), and transfer from other hospitals (n=5, 17.9%). The reason for their admission was related to autoimmune disease activity in 16 (57%) – relapse (4), newly diagnosed (6) or diagnostic work-up (6). In a further 12 patients (42%) – 7 had infections, 1 hip fracture, 2 DVT/PE and 2 GI bleeds. 7 (25%) had evidence of an acute kidney injury at presentation. 3 had renal biopsies, 4 line insertions for dialysis and 4 patients had PLEX. Patients had inter-disciplinary review by 17 other specialities, with respiratory review most frequent (13%), followed by rheumatology and haematology (11%). During the period of the study, none of the patients required intensive care. The median number of patients seen per day was 6 [IQR 4.75 – 6.25], with a median number of 4 inpatient admissions [IQR 3-6] and 1 consult [1-2]. The median number of new admissions per month was 10.5 [IQR 9.75-11.25] and new consults reviewed per month 7.5 [IQR 6.25-8.25], with the number of discharges 13 per month. Regarding the 15 consults cases that were seen over two months, the reason for referral was to confirm the diagnosis of autoimmune disease in 40%, review for consideration of a possible diagnosis of autoimmune disease in 27% and to provide management advice in 33 with a known pre-existing autoimmune disease. The referring disciplines were respiratory (27%), general medicine (20%), obstetrics and gynaecology (13%), neurology, rheumatology, ENT, emergency department and gastro-enterology (7%), other hospitals (7%).<br> <strong>Conclusion:</strong> The in-patient service was directly responsible for inpatient care and for the provision of a consultation service within the hospital, regionally and nationally. The service provided expertise in newly suspected vasculitis to both confirm and exclude the diagnosis. Multi-disciplinary organ management was engaged by the vasculitis team ensuring a timely coordinated management approach for patients. The inpatient service enabled rapid inpatient admission to facilitate early commencement of treatment, with discharge to vasculitis clinic minimizing inpatient stay, and implementing a longer term outpatient management plan.<br> <strong>Disclosures: </strong>David Jayne’s disclosures of commercial conflicts for companies with marketed products for 2021 are: Astra-Zeneca, Aurinia, BMS, Boehringer-Ingelheim, GSK, Janssen, Novartis, Roche/Genentech,Takeda &amp; Vifor. AE, CB have nothing to declare. <br> <strong>Table 1.</strong> The In-patient Vasculitis Service at the Vasculitis and Lupus Unit, Addenbrooke’s Hospital, Cambridge.