Abstract
BackgroundPrevious studies have reported delays in the investigation and suboptimal management of hot swollen joints, particularly crystal arthritis. In our hospital, it was noted that synovial fluid was inconsistently analysed for crystals which may lead to patients receiving delayed treatment.ObjectivesThe aim of this quality improvement project was to 1) identify the number of synovial fluid samples that were not checked for crystals 2) implement changes to improve this process 3) re-audit and commitment to a continuous evaluation.MethodsRetrospective review of synovial fluid analysis requested for adult patients presenting with hot swollen joints over a six month period. Following, the implementation of changes in the hospital, another comparison of pre-post intervention was performed.ResultsA total of 106 synovial fluid samples were sent for analysis between March and August 2021, of which only 69 (65%) of the samples were analysed for crystals. All samples were analysed for microscopy and culture. Following involvement with IT and laboratory departments we have introduced an intervention to make requesting crystal analysis easier. The request for synovial fluid analysis was grouped in a bundle (reflex test) so whenever a synovial fluid is collected, two forms are generated, one for microbiology (microscopy and culture), and the other for cytology (crystal analysis). Additional interventions included education and raising awareness. Post-interventions, another three month analysis of synovial fluid showed that compliance improved to 78%.ConclusionThere was an improvement in the synovial fluid analysis requests of patients with hot, swollen joints. By implementing these changes and raising awareness, patients with acute crystal arthritis can be treated in a timely manner. We plan to continue our work with synovial fluid analysis following re-review and will continue to generate improvements.Disclosure of InterestsNone declared
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