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Increased use of Digital and virtual video consultations, pre screening suspected urgent patients from primary care prior to referral to the Trust.
During the COVID-19 pandemic i am pleased to say not a single day of patient care was interrupted. We continued to provide services and switched from face to face consultations to virtual and telephone consultations within a matter of days.
We continued to run full clinics of 12-15 patients per day, we continued to offer urgent slots for new PMR patients, new swollen joints and continued to operate a advice and guidance and flare up service with a turn around time of 24 hours.
We managed to significantly reduce any referrals to the secondary care trust by screening all new patients with a telephone call to ensure they were in fact new connective tissue disease patients or early inflammatory arthritis patients.
This pandemic has really shown us the value of virtual and telephone clinics.
What is needed to sustain the change?
What is your region?
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Really helpful outline of your response to the covid circumstance in primary care- could you give more detail on the profession model of who is undertaking the screening of the referrals and share any screening resources/tools /criteria being used to undertake the screening of the referrals for these suspected conditions- thank you
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Dear Carol Thank you for your comment and i am happy to share this information. We have a very well established Community Rheumatology service which is currently staffed by One Extended Scope Rheumatology physiotherapist, One full time consultant Rheumatologist, One locum Consultant Rheumatologist, One developing Rheumatology ESP and two specialist Osteoporosis nurses.
The screening is being done by the members of staff above and takes the form of a full telephone consultation in which a full clinical history is taken, video consultation is done to examine reported swollen joints, blood tests from primary care are reviewed and limited examination via video consultation are done such as self MCP/MTP squeeze test. If additional urgent bloods are needed these are arranged
Currently our trust (Secondary care) are only accepting EIA referrals based on the criteria attached which we screen for as well as Connective tissue disease which we also screen for in terms of typical symptoms such as positive ANA, raynauds disease, ulcernation, rash, non erosive synovitis and other system involvement depending on the spectrum of CTD.
I think this model has definitely shown us that such initiatives can greatly reduce the amount of referrals that go directly to sec care and i firmly believe by doing this we can really improve on figures such as the AxSpA delay to diagnosis and EIA waiting time and accuracy of patients presenting in the EIA clinic.
We have also seen certain cases F2F such as those suspected for possible PMR with headaches to exclude GCA, angry suspected CPPD joint to exclude septic joint and patients for IA joint injection with a Angry Monoarthropathy rheumatoid Flare with the appropriate PPE.
We have also experimented with taking BASDAI scores, DAS 28 scores etc via virtual consultation although i must admit this was a challenge.
Happy to share any further information
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Status labels added: Effective Team Working, Information Sharing, Pathway Redesign, Patient Selection, Prim/Sec Integration, Referral Pathway Redesign, Screening, Technology (Software/ Apps), Telephone Advice, Telephone Consulting, Video Consulting, Virtual Consulting, Horizon 2
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Status labels added: Prim/Sec/Com Integration, Triage
Status label removed: Prim/Sec Integration
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The idea has been progressed to the next milestone.
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Status labels added: Upskilling Of Staff, Workforce
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Status labels removed: Effective Team Working, Information Sharing, Pathway Redesign, Patient Selection, Prim/Sec/Com Integration, Referral Pathway Redesign, Screening, Technology (Software/ Apps), Telephone Advice, Telephone Consulting, Triage, Upskilling Of Staff, Video Consulting, Virtual Consulting, Workforce
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