BACKGROUND: Dynamic function tests are needed to diagnose a range of endocrine disorders but often require in-patient investigation. A recent audit of our endocrine service revealed deficiencies that included frequent delay to investigations and cancellation of planned appointments. We developed an Endocrine Nurse Specialist (ENS) post whose role included carrying out endocrine testing in an out-patient setting to assess whether this might improve quality of care for our patients.
METHODS: Our initial audit was a retrospective case notes review and questionnaire sent to patients undergoing endocrine testing during the previous 16 months. These tests included short synacthen, insulin stress test and fluid deprivation. Following the appointment of an ENS, prospective data was collected over a 7 month period.
RESULTS: Prior to the ENS post being introduced 59 tests were performed. Only 24% of patients had their test performed within one month of the request. 14% had planned investigations cancelled. Of these 40% made an unnecessary trip to hospital.
Following the ENS post being introduced 46 tests were performed. 98% had their test performed within 1 month. This represented a significant improvement (p<0.002, chi-square=57.7, df=1). Only 1 patient was cancelled (with adequate notice).
DISCUSSION: There are approximately 150 ENSs in the UK. Many of these perform endocrine tests. There is currently no published data demonstrating that this improves patient care. We have shown that introducing an ENS into our endocrine department improves patient access to endocrine investigation. Additional benefits are likely to include prompt diagnosis, improved reliability of test results, a more co-ordinated system for review of results and better communication with patients and other healthcare professionals. Over-stretched hospital trusts may be pleased to note that in-patient medical beds may also be freed for other purposes.
24 - 26 Mar 2003
British Endocrine Societies