POS1385 IMPROVING AXIAL SPONDYLOARTHRITIS TIME TO DIAGNOSIS: A QUALITY IMPROVEMENT PROJECT
Authors: T. Gudu, S. Voules, C. Kelly, M. Alcala, S. Premraj
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The average UK time to diagnosis for axial spondyloarthritis (axSpA) remains unacceptably long, i.e., 8.3 years, affecting patient quality of life and function, and with high societal and economic costs. Up to the end of 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. <h3>Objectives:</h3> 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. <h3>Methods:</h3> 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, establishing connections with primary and secondary care, and providing education on axSpA to health professionals. To evaluate improvement in time from patient presentation in primary and secondary care to axSpA diagnosis, we have audited all new suspected axSpA cases in the first 3 months of service inception (November 2021 – February 2022) and compared it to the same period a year later (October 2022 – February 2023). The Plan-Do-Study-Act (PDSA) methodology was used. The driver diagram of the quality improvement project is depicted in Figure 1. <h3>Results:</h3> We have 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 [1]. 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 (MDT) meetings with dermatology, ophthalmology, spinal team, as well as with community physiotherapy. Regular education sessions were delivered to primary care, including general practioners and physiotherapy services. A specific radiology-MRI pathway was also established in collaboration with the radiology department to reflect the British Society of Spondyloarthritis (BRITSpA) recommendations [2]. 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 first rheumatology review decreased from a median of 17 weeks to 5 weeks (Figure 2) and the time from first rheumatology appointment to definite diagnosis of axSpA from 17 weeks to 7 weeks. Overall, patients with axSpA had to wait 13 weeks from initial presentation to diagnosis in rheumatology versus 29 weeks at service inception. <h3>Conclusion:</h3> In only a year, we have established an axSpA service <i>de novo</i> with clear and standardized pathways. There was a significant improvement in waiting times for patients waiting to be referred and diagnosed with axSpA. <h3>REFERENCES:</h3> [1] https://www.nice.org.uk/guidance/ng65 [2] Bray TJP, Jones A, Bennett AN, et al. Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK. Rheumatology (Oxford). 2019 Oct 1;58(10):1831-1838. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>