Increasing the efficiency and quality of follow up clinic visits for patients with inflammatory arthritis.

The overarching principal goal of the change project described in this dissertation is to make the clinic visit for a rheumatology patient with inflammatory arthritis more efficient, more effective and of better quality, when compared to their current experience. Changes to both structure and process of how return patients are assessed will be introduced to facilitate these changes. This entailed pre-recording and ordering relevant clinical tests (blood tests and radiographs), and having patients return to clinic having completed a pro-forma that will include a list of current medications, as well as medications that have previously been tried for their arthritis.

As treatments for inflammatory arthritis have become more successful, it has become clear that clinical outcomes are much improved when appropriate treatments are commenced early. Changes to how arthritis referral centres work are required in order to approach the problem of meeting the target of reviewing patients referred by primary care physicians who suspect inflammatory arthritis within six weeks.

The change occurs in the context of ongoing planned and emergent change both in the macro- and the micro- context. The case for the importance of physicians leading and managing change is made herein.

The change was a qualified success. At the time of writing it had been shown to be possible to see an extra new patient in clinic, as a result of the efficiency gained. 131 patients were included in the analysis. The average time for a physician to review a patient was reduced from 23 to 15 minutes, but in the present form it must be noted that a physician spends 14.8 minutes preparing for the patient visit. 91.6% of patients had a validated disease activity score calculated; this was only very rarely done beforehand. 92.37% had radiographs taken within two years which compared with 51.9% who had these taken previously. All patients had their data entered into a registry database.