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#NHSChangeChallenge

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Rheumatology

28 Ideas
22 Votes
162 Comments
30 Subscribers

Please outline the key changes in care for patients being seen by rheumatology services.

We are interested in changes at every stage of the pathway that has taken place so far during the Coronavirus pandemic and should be sustained during the next phase and beyond.  Please use this challenge for changes that are specific to rheumatology.  

We’re keen to hear about changes that may relate primarily to patients, staff, and the wider health system.

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    Melanie Martin
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Using 2-way SMS communication for blood test reminders

Patients have had the opportunity to engage with a 2-way SMS service in our rheumatology service for over 1 year. The channel has been used Predominantly to send and receive patient-reported outcome measures. During Covid-19 we have been using the 2-way communication channel to co-ordinate blood tests to be performed locally to the patient/in primary care rather than travelling to the hospital for routine bloods. Patients have been able to email results in to the department and the SMS...

2

Use of video conferencing to facilitate joint specialty consultation

Many of our idiopathic inflammatory myositis patients have coexistent pulmonary fibrosis and are immunosuppressed.  I manage my patients in conjunction with a tertiary centre to facilitate access to IVIG and/or rituximab etc that require NHS England funding.  My tertiary rheumatologist colleague, myself and one of our patients with IIM will video consult in the next two weeks via Attend Anywhere, and consider whether we should submit a funding application for rituximab treatment.  This may...

2

Introduction of a drive-through pharmacy to help patients/carers collect medication without having to set foot inside the hospital. This allowed for continuation of rheumatic medications to prevent missed doses and possible flares.

The drive through model has been well received by patients and clinics as it has provided patients who regularly come into hospital to collect their ‘hospital only’ medications with ease and not the need to park and walk into the building to collect.  All patients are sent a text message informing them their medications are ready of collection and any patient who does not have this option will be contacted by telephone.   

1
Horizon 2

Telecommunication - Patient Choice

During Covid-19 ensuring the accessibility of our service was critical for patients to feel cared for at home. We increased the number of online telephone appointments by recruiting professors, consultants and registrars to engage in online telephone appointments, A role usually held by nurses. It has helped the wider team gain insight and respect the role each other plays within our service. Where possible we used our service website and remote monitoring SMS service to encourage those...

8 Points
5
Horizon 3

Remote monitoring

We have run a SMS based remote monitoring service for patients with rheumatoid arthritis for over a year. Patients receive a monthly PROM  via SMS. During the covid-19  pandemic a number of SMS templates were generated to distribute up to date links to guidance on shielding, medication, managing emotional well-being and physical activity during lockdown and appointment deferment via 2-way communication. Patient engagement has been extremely high throughout the introduction of this service....

8 Points
4
Horizon 2

Redesigning the Rheumatology telephone service

Access to information and people when patients needed it the most  during the Covid-19 pandemic was a top priority. Many patients use our telephone service to book, rearrange, cancel appointments, seek advice, request prescriptions and information such as letters and results. Prior to covid we were aware that there were many pain points in our telephone system which prevented patients reaching the right person first time. Following a review of the type of calls Received by nurses,...

4
Horizon 2

Increasing options for delivery/collection of hospital prescriptions e.g. by post, by home delivery and by drive though as well as patient collection

Previously patients on conventional DMARDs that were prescribed by their treating hospital probably had to collect their drug prescriptions from the hospital pharmacy. To reduce footfall and queues in hospital pharmacies, all hospitals have considered how to improve this as a result of COVID-19. Other options are now available at different hospitals. I am aware of trusts delivering drugs to a patient's home, posting drugs or offering a drive through facility- all of which have been popular...

6.5 Points
5
Horizon 1

Self- reporting risk scoring

Rapid identification of high risk /extremely vulnerable patients who should shield during the covid-19 pandemic was a challenge due to the incomplete data held in secondary care regarding multi-morbidities. We identified that patients could rapidly provide updated health information which could inform a more accurate risk  score based upon the BSR risk stratification tool. We formed a ‘risk’ clinical group and held daily virtual huddles via VC to focus on generating the list for NHSE. We...

4 Points
5
Horizon 1

FAQ page on service website

It sounds so obvious, but an FAQ page on our rheumatology service webpage saved us!   https://www.guysandstthomas.nhs.uk/our-servic...-questions.aspx Prior to Covid, our website was definitely  Under-utilised. The high volume of frequent emails, calls and voicemails were initially themed around risk stratification, shielding, medication initially so we developed these as priority FAQs. As the nature of the calls, emails changed to flares, blood tests, physical inactivity - we updated...

7.5 Points
7
Horizon 3

Development of Hybrid Clinics

Deconstructing old clinic templates and  develop new hybrid model ( video, telephone, face to face, patient initiated follow up)   Improved patient access and convenience using video technology with a 9 fold increase of its use    Patient owned data with outcome measures  (PROMS) Reduced travel and congestion in hospital Improved monitoring Patients seen quickly when they need it most More flexible working for a mobile workforce using virtual MDTs on Teams More...

7 Points
8
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