266. STREAMLINING A RHEUMATOLOGY-BASED ULTRASOUND SERVICE IN A LARGE URBAN DISTRICT GENERAL HOSPITAL

Abstract

Background: Musculoskeletal (MSK) ultrasound (US) scanning is established as a useful clinical tool in decision making and improving clinical outcome in patients with inflammatory arthritis. The aim of this study was to review the impact of the introduction of a dedicated early inflammatory arthritis (EIA) ultrasound clinic to an existing general MSK US clinic and to review any change in referral patterns. Methods: All patients who were referred to the rheumatology musculoskeletal ultrasound service were analysed within a three month time period. 147 referrals were made between 3 June 2016 to 2 September 2016. Three Consultant Rheumatologists carried out and reported the ultrasound scans. Scans were carried out using a GE Logiq E machine. Synovitis was defined as grey scale synovial hypertrophy or tenosynovitis, with or without hyperaemia. Data were collected from both paper and electronic patient records. Results: 6 patient records were missing, hence a total of 141US scan referrals were included in our analysis. Of these 141 referrals, 5 did not attends (DNAs). 122 (86.5%) of referrals were for early inflammatory arthritis (compared to 71% the year before). The two most frequently requested US scan were as follows: hands and wrists (52.5%), hands and wrists and feet (21.3%), similar to the previous year. The majority of referrals were US scan alone (94.3%). Out of 141 scans, 43 patients (30.5%) had synovitis, 84 (59.6%) had no synovitis, 9 patients (6.38%) had no diagnosis, 5 patients (3.55%) were DNAs. The US scan reports influenced the clinical decisions as following: for 20 patients (14.2%) a disease modifying anti-rheumatic drug (DMARD) was started, for 6 patients (4.26%) a biological therapy was started, for 2 patients (1.42%) the current DMARD was continued, for 2 patients (1.42%) physiotherapy was recommended, for 2 patients (1.42%) hand therapy was recommended, for 2 patients (1.42%) further imaging was recommended, for 1 patient (0.709%) podiatry referral was recommended, for 1 patient (0.709%) the DMARD was stopped. A therapeutic intervention occurred as a result of the MSK US in 84.8% of cases similar to the previous year. The discharge rate from the Rheumatology service as a result of the scan was 4.97% compared to 24% the previous year. 3 joint injections were carried out. Conclusion: A higher percentage of patients scanned had been referred for EIA, possibly as there were dedicated EIA slots. Introducing a second dedicated EIA scanning clinic builds in resilience to a rheumatology based MSK US service without diluting the impact on therapeutic intervention.