THU0643 Impact of shoulder ultrasound in quality of care indicators in patients with recent onset of pain
Authors: C.A. Guillen-Astete, R. Penedo Alonso, C. De La Casa Resino
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Ultrasound is a technique that has demonstrated diagnostic accuracy in the periarticular pathology of the shoulder. Although its value is not questioned, any diagnostic or therapeutic instrument must also demonstrate a beneficial impact for the patient in terms of quality of care. The quality of care can be measured by direct indicators (satisfaction surveys, waiting times) or indirect ones (referral rate, need for new consultations). We do not have studies that measure the impact of ultrasound in the assessment of hyperacute shoulder pain or of recent onset (less than a week) pain. <h3>Objectives</h3> Our purpose is to determine to what extent its use modifies three indicators of quality of care in relation to hyperacute omalgia of non-traumatic origin. <h3>Methods</h3> We conducted an analysis of three indirect indicators of quality of care: Need for reassessment due to pain (NRD), specialised referral rate (TDE) and length of stay in the emergency room (TDU). Records of patients treated for acute omalgia between 2014 and 2016 were reviewed and classified according to whether or not ultrasound was used as a diagnostic tool. For the statistical analysis we used the Student's T test, Fisher's exact test and survival curve (for TDU, TDE and NRD, respectively). The design used was that of a retrospective descriptive study. The information on waiting times was obtained from the CAJAL registry, information on new consults and specialised referral registration were obtained from the HORUS program and CAJAL registry. A comparative retrospective study was carried out based on the usual clinical practice. We examined the records of patients treated between 2015–2016 in the rheumatological emergency unit, who were known diabetics and who underwent an ultrasound-guided infiltration. Using the HORUS program we reviewed the patient's files of the immediate outcome after infiltration and the follow up consults. <h3>Results</h3> We included 1433 records of patient. Of these, 547 (38.1%) were examined with ultrasound assistance (Group-ECO) from which 2 were performed by a radiologist and the rest by a trained physician (Rheumatologist or Family Physician). The rest of the assessments, 886 (61.8%) were made without using the ultrasound (Control group), although in 540 cases a different imaging test was used. At 30 days after the first assessment, 90 patients (10.1%) in the control group had consulted again (56 due to emergencies and 34 per AP), while in the ECO-Group 14 (2.5%) consulted again at least once (12 for emergencies and 2 for AP) (p&lt;0.001). The referral rate to the specialist in the Control-Group was 36.5%, while in the ECO-Group was 6.21% (p&lt;0.0001). The average stay time was 94.5 DE 34.3 min in the Control Group and 105.4 DE 40.1 min in the ECO-Group (p&lt;0.0001). <h3>Conclusions</h3> The use of ultrasound as a diagnostic tool reduces the need for re-evaluations of patients and the rate of referrals to the specialist in a significant way. On the contrary, it increases the patient's stay time in the emergency room, probably due to delays in the availability of the equipment to perform the diagnostic procedure. Globally, our results show that most quality health care indexes improve in patients assessed by using ultrasonography. <h3>Disclosure of Interest</h3> None declared