The Endocrine service is predominantly out-patient based looking after a range of conditions with strong dependence on biochemical monitoring for clinical safety. Due to capacity demands we needed to explore the options available to facilitate safe monitoring with potential to increase capacity.
The development of an IT based system allowed for the capacity increase, provided prompt communication with GPs, improved patient safety, included a diagnostic coding element and demonstrated a cost saving.
The tracker is run by the Endocrine Nurse Specialist and includes thyroid patients on block and replace or following radioactive iodine, monitoring following pituitary irradiation, conservatively managed hyperparathyroidism, and so on. Crucially the tracker prevents situations such as a hyperparathyroidism patient needing hospital admission to resolve hypercalcaemia as the GP had not checked the calcium as requested. The current caseload is 340 patients with a total 550 patients managed using the tracker since its inception in November 2013. The tracker has generated 1500 letters since June 2014 when letter templates were added.
Cost savings are difficult to quantify however clinic coding within the tracker and Trust IT systems differentiate face to face encounters and telephone consultations ensuring correct tariff remuneration. Prior to the tracker a new thyrotoxicosis tariff would be in the region of £370 470 for the first 12 months including a Consultant first visit and 2 or 3 more reviews by Consultant, Registrar or CNS. That cost has reduced since using the tracker to around £230 including the Consultant first visit. All follow ups are done by the CNS using phone consultations whenever possible up to the point of discharge.
The next step will be to audit patient satisfaction with the service development and enhance the tracker by adding patient cohorts such as thyroid cancer thyroglobulin monitoring.