AB1048 The Transformation of Inpatient Rheumatology Services in A Post-Biologics Era

Abstract

BackgroundOver the last 15 years the rapid development of an armoury of biological drugs has revolutionised the management of inflammatory arthritis and other rheumatological conditions1. In the past Rheumatology inpatient wards were largely occupied with patients with difficult rheumatoid arthritis and associated extra-articular disease, with little option bar synthetic DMARDS, corticosteroid, respite and physiotherapy.ObjectivesIn 1996 we audited inpatient services for the month of February within the Belfast Rheumatology Unit and a report was issued as a result of this to help plan service development. Twenty years later we repeated the audit.MethodsWe audited the inpatient admissions between 5th October 2015 and 5th November 2015. Data was collected contemporaneously by reviewing the medical notes whilst the patients remained on the ward and any omissions filled in retrospectively using our local database NIECR. Information collected included age, gender, method of admission, diagnosis on discharge, duration of admission, procedures carried out, allied health professionals inputting, radiology services required and onward referral as inpatient to other specialities. We compared this to the audit report from 1995.ResultsThe audit discovered that there was some similarities between the two eras including:1) Inpatients remain predominantly female – 77% in February 1996 compared with 88% in October 2015.2) Emergency admissions remain in the minority – 17% in February 1996 compared with 25% in October 2015.3) 59 patients were admitted to the ward in February 1996 compared with 44 in October 2015.4) The mean age of our inpatients was 56 years. The commonest age interval in 1996 in both males and females was 45–64.Conversely there are a few notable differences including;1) In 1996 there were 44 beds in the department compared with 16 beds currently.2) In 2015 21/44 patients were elective admissions to the ward for administration of Iloprost or Flolan. Other common reasons for admission included multiple joint injections (5/44) and flares of inflammatory arthritis (4/44). In 1996, 23/49 patients were admitted for the management of flares of inflammatory arthritis. This represents a 38% reduction in admissions for disease flares.3) Less patients required access to the multidisciplinary team (MDT). In 1996 85% of patients were reported to access inpatient physiotherapy, compared with 52% in 2015. 80% of patients in 1996 were said to access OT, but it was 18% in 2015.4) The mean length of stay in 1996 was 11.8 days, compared with 7.1 days in 2015.ConclusionsOur ward serves a comparable number of patients nowadays, as it did in 1996. However the inpatient population has certainly evolved. Better treatments for inflammatory arthritis have reduced the number of admissions to manage flares. Those patients that are admitted, stay for a shorter time and require less MDT input, perhaps due to less acquired disability.ReferencesKatherine S. Upchurch and Jonathan Kay. Evolution of treatment for rheumatoid arthritis Rheumatology 2...