P003 A fast track giant cell arteritis pathway incorporating ultrasonography improves service provision in a District General Hospital

Abstract

Abstract Background/Aims Giant cell arteritis (GCA) is the most common form of adult vasculitis with comorbidities including blindness. Early identification and initiation of treatment is therefore essential. The 2020 BSR guideline suggests specialist review within three days of suspected GCA. In Ipswich Hospital, there was previously no universal referral pathway for GCA. Patients were referred to the acute medicine, A&E, rheumatology or ophthalmology clinics. An audit in 2018 over 18 months highlighted a significant delay in specialist reviews. In 2021 we designed a rapid access referral pathway for direct specialist review (protected one-stop slots in rheumatology or ophthalmology), including the use of a dedicated score for assessing the risk for GCA (GCAPS) and vascular ultrasonography in specialist clinics. Our aims for this quality improvement project were to: 1) Audit referral times for suspected GCA patients 2) Optimise the percentage of suspected GCA cases receiving a confirmatory test, notably ultrasound or temporary artery biopsy. Methods We audited the new GCA referrals from January 2022 to June 2023, and compared to the 2018 data. Data were retrospectively collected from electronic health records. Results 44 patients were included (women=29, mean age=68). In 2023, 89% of patients were seen within three days, compared to 47% previously. In 2023, patients were reviewed within a median of two days by a specialist compared to 19 in 2018. Finally, 100% of our patients received a diagnostic test, compared to 79% previously (table 1). A total of 34% of new referrals were diagnosed as GCA. 40 patients had an ultrasound which was positive in 27%, equivocal in 25% and negative in 48%. For the remaining four patients, GCA was excluded without imaging tests/biopsy. 17 patients had biopsy, with 24% being positive for GCA. 52% of referred cases had high GCAPs score and 32% normal inflammatory markers. Conclusion Our fast-track referral pathway facilitated an earlier review for our patients. These results indicate the enhanced safety afforded for suspected GCA patients via a dedicated Fast Track GCA assessment clinic with access to ultrasonography. This also led to a significant reduction in the number of temporal artery biopsies required. Disclosure D. Ioannidis: None. S. Premraj: None. E. Ntatsaki: None.