i043 The impact of an in-house rheumatology ultrasound service on patient care and care pathways

Abstract

This session describes our experiences of working with a dedicated and embedded rheumatology ultrasound service, its impact on patient pathways and experience. We describe a service which US is highly accessible, delivered efficiently and responsive to patient needs. Our Musculoskeletal Ultrasound Service (MSKUS) has developed from a single part-time consultant sonographer in 2009 to a team of sonographers, ultrasound nurse and consultant. The expansion over time has been led by organic increases in demand both in terms of volume and additional roles for ultrasound, as clinicians' familiarity with ultrasound matured but was reliant on the MSKUS being able to set its own priorities in response to the needs of clinicians and patients. The same autonomy also allows us to provide appointments in a timely fashion, triaged according to clinical need. The multidisciplinary team of MSKU (sonographer, rheumatology nurse, rheumatology doctor) constitutes a breadth and depth of knowledge of both ultrasound and rheumatology, providing patients with immediate answers and tailored treatments. Additionally, this model proves cost-effective as compared with one delivered by radiology consultants. Based within the rheumatology unit, staff participate in a dialogue as required with the rheumatology team, in addition to providing written reports. The role of US in detecting subclinical synovitis in patients with potential early inflammatory arthritis is well recognised and we use this to facilitate early treatment or discharge. Alternative diagnoses such as crystal arthritis and OA can also be detected readily. Over time, we have increased use of US in disease surveillance, to provide objective evidence of disease activity where uncertainty exists, especially in biologic patients, and avoiding inappropriate escalation or switching, costs and risk to patients. Normal appearances or visual cues indicating active inflammation can assist patients' understanding of their condition. USG injections are more accurate than those given by clinical guidance and this may translate into improved outcomes as well as improved patient satisfaction. We have steadily increased our use of ultrasound guided injections, which are now standard for small joints and tendon structures and may be used in other sites according to criteria. Joints requiring guidance such as hips may be injected without referral to other specialities. Highly autonomous MSKU staff can provide one-stop combined diagnostic and injection appointments in difficult anatomical areas such as shoulder or foot and ankle, allowing appropriate immediate treatment for regional problems; alternatively, proposed injection targets may be altered. Responsive to the requirements of the department, we are supporting a project in tapering biologic drugs and diagnostic scanning in suspected temporal arteritis. Our experiences suggest that the addition of ultrasound imaging to the existing rheumatology MDT can improve patient experiences, satisfaction and outcomes.