P012 Using the BSR Lupus audit as a springboard to improve management of SLE in the outpatient clinic

Abstract

Abstract Background/Aims In 2018, following BSR Lupus guidelines publication, we took part in the national multicentre Lupus audit. Audit standards developed by expert consensus to assess baseline care in the outpatient management of SLE were used. We present a series of audit cycles spanning the development of a connective tissue disease (CTD) service and a trust merger capturing quality improvement work that has been informed by audit results. Methods In 2018, participating in the BSR audit, 15 patients attending a non-specialist rheumatology clinic over a 4-week period were enrolled. In 2019, Liverpool University Hospitals NHS Foundation trust was formed following the merger of two large teaching hospitals. A trust-wide CTD service was established in 2020. The audit was repeated in 2020 including all 119 patients seen over a 12-month period with SLE. Conclusions informed two QI workstreams: urine sample collection and the development of an SLE review form for the electronic notes and electronic SLEDAI score. A further audit cycle was performed including 40 patients following the implementation of these changes selecting patients across both hospital sites seen both in general and specialist clinic settings. Results In 2018, 5/11 audit standards were met, 3/11 in 2020. In 2022 across all clinics 4/11 standards were attained, however this improved to 9/11 in the specialist clinic (see table). In 2020, only 22% of patients had their urine tested; following a QI project (including nurse education and inclusion on clinic observation form) this improved to 90%. Following introduction of the electronic SLE review form, when used, audit standards were met in all areas (9/11) apart from lipid testing and discussion of pregnancy (79% of patients vs standard of 80%). Conclusion Using the BSR audit as a tool to spearhead QI projects in our newly merged trust and CTD service, clear improvements have been made. The development of an SLE review form which can be used in all non-specialist rheumatology clinics prompts clinicians to target key audit standards, in turn improving patient care. Further departmental implementation will help drive further improvement with particular focus on SLEDAI assessment and lipid monitoring. Disclosure R.M. Benson: None. C. Cotton: None. I. Soares: None. D. Mewar: None. Z. Mclaren: None.