SAT0731-HPR TRIAGE AD HOC REFERRAL BY RHEUMATOLOGY NURSE – AN ALTERNATIVE PATH TO CLINIC VISIT
Authors: Cheung Yin Shuen, Lee Pik Fan, Leung Man Chi, Lam Chi Kwai, Chan Ching Man, Ng Woon Leung
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatic diseases are chronic conditions characterized by disease flares and remissions. Patients are often referred back from other healthcare providers in between follow-up visits when they seek attention for disease flares or adverse effects from treatment. While prompt attention and assessment is important, the busy rheumatology clinic may not have the coping capacity for these ad hoc needs. Rheumatology nurse (RhN) can play a pivotal role in triaging these referrals. <h3>Objectives:</h3> The study aims to evaluate the safety of referral triage by rheumatology nurse and the effectiveness in alleviating workload of the rheumatology clinic. <h3>Methods:</h3> This was a retrospective study. Data were retrieved from November 2016 till December 2018. Ad hoc referrals to the rheumatology out-patient clinic were screened by rheumatologists and suitable cases were directed to RhN for further handling. The triage process included phone triage or attendance of RhN clinic for assessment and subsequent phone follow-up. Investigations including laboratory and radiography were arranged as indicated. Frequency of phone follow-up after the first contact depended on patients' needs. Patients would be referred to rheumatologist for further management if the condition worsened at or before the first phone follow-up. <h3>Results:</h3> Totally 110 referrals were triaged by rheumatology nurse with 54 arthritis, 28 systemic lupus erythematosus, 10 vasculitis, 8 undifferentiated connective tissue disease and 5 others. Age ranged from 22 to 84 years and 82.7% were female. Sources of referral included general out-patient department (38.2%), emergency department (22.7%), other specialists (33.6%) and general practitioners (5.5%). Reasons for referral included disease flare-up (47.3%), drug-related problems (20.9%), abnormal investigation results (12.7%) and alarming clinical presentation (19.1%). Mean time interval from referral to first phone contact was 3.8 days. Of the 110 cases, 20 patients had follow up advanced; 1 patient was admitted before phone triage and 86 patients could follow original appointments. Two of the 110 patients' symptoms subsided spontaneously and no intervention was required; 1 patient was arranged admission after discussion with rheumatologist. No record of emergency attendance or admission for the 86 patients who kept the scheduled appointment. Nursing interventions included drug education and advice (64 episodes), disease education (20 episodes), investigation arrangement (50 episodes), counselling and emotional support (12 episodes). Three patients attended RhN clinic for assessment and education. The other 83 patients were managed through phone communication and majority (81.4%) had phone follow up once. <h3>Conclusion:</h3> The result of the study showed that referral triage by rheumatology nurse is safe and effective in handling the majority of ad hoc referral requests. The service can promptly address patient needs and reduce clinic visit burden of the rheumatology clinic. <h3> Disclosure of Interests:</h3> None declared