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The National Early Inflammatory Arthritis Audit has now been running for 18 months, working to identify areas of improvement within Trusts and Health Boards in England and Wales.

We heard from Dr Catherine Morley, consultant rheumatologist at City Hospitals Sunderland NHS Foundation Trust, about the challenges the rheumatology department faced, and how its performance improved as a result of the audit.

Dr Catherine Morley, City Hospitals Sunderland

At Sunderland Royal Hospital, early arthritis triage was initially via Choose and Book. GPs would book patients into the early arthritis clinic, so a patient would be given a clinic slot with a date. Triage was then done by all consultants at a later date. If the consultant felt the referral was inappropriate, the patient would be triaged out. We had 10- 12 early arthritis slots per week but still could not improve the NICE Quality Statement 2 (time to first appointment). We tended to run at 24% of patients seen within 3 weeks of referral.

What did we change?

In March 2019, we altered our triage to have an early arthritis “pool” into which the GPs could refer; but this way no dates were given to the patients by the GPs. Two rheumatologists with an interest in early arthritis now triage these clinics (we have seven rheumatologists).

We have audited the new triage system and we have not missed any patients with EIA with the new method. Those triaged out had the following diagnoses; osteoarthritis , transfers from another hospital with a known diagnosis of inflammatory arthritis, no diagnosis made, gout, trigger finger and carpal tunnel syndrome.

Performance improvement

Since changing our triage system, our QS2 performance has improved from 24.8% to 66.1%. Over the last six months we have accepted into the early arthritis clinic an average of 53% of referrals (44%-64%).

Looking to improve your own service? Find supporting materials such as driver diagrams and clinic prompts to help support units on our audit webpage.