POS1488-HPR CAN A SPECIALIST NURSE LEAD A COMPREHENSIVE OSTEOPOROSIS SERVICE WITH REMOTE SUPERVISION – AN INNOVATIVE CONCEPT
Authors: D. Masieh, J. Begum, J. Fourmy, M. K. Nisar
Journal: Annals of the Rheumatic Diseases (2021)

Background: Specialist services traditionally rely on a consultant to lead a multidisciplinary team and provide patient facing activities. However, demand outstrips the limited expertise available and therefore significant delays occur in treatment pathways. There is an urgent need to expand the skill set of the employed workforce and think ‘outside the box’. A service run by clinical nurse specialists (CNS) can be an effective solution. CNS are already an integral part of multidisciplinary teams caring for a diverse range of patients including those with chronic conditions such as osteoporosis. Objectives: We designed an innovative osteoporosis service with patients consulting only a metabolic bone CNS with a consultant rheumatologist 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 while 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 Rheumatologist-CNS virtual MDT. An 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 the patient journey to the conventional pathway, obtained the number of consultant follow-up appointments saved by implementing this service, and calculated total savings. Results: In the pilot phase, 116 patients were triaged into the new service. The patient cohort was a combination of new referrals and patients taken from the consultants’ waiting lists. The mean age of the participants was 78 years (65-93). The median time: from referral to virtual triage was 20 days (0-308); from triage to new patient CNS telephone consultation was 20 days (0-137); and from virtual MDT to treatment authorisation was zero days (0-331 days). 45 patients had anabolic therapy commenced via home care. The remainder 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. 116 new patient consultant appointments were saved and the 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 CNS 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 address thinly stretched health care resources for people with chronic conditions. Disclosure of Interests: None declared