Background: In December 2017, a Nurse-Led AI clinic was introduced at University Hospital of Wales, Cardiff for the evaluation and follow-up of these patients. The clinic pathway was based upon the 2016 European Society for Endocrinology (ESE) guidelines on the management of adrenal incidentalomas.
Aim: To evaluate the effectiveness of this new service and the cost-saving benefit.
Methods: Electronic and paper-based patient records were evaluated from December 2017 to April 2019. Total numbers assessed, referral times, time to discharge, numbers needing consultant follow-up and estimated cost savings were evaluated. Cost-savings were calculated in comparison with the previous management of AI.
Results: A total of 68 patients were seen over the 17-month period. The mean time from the initial CT prompting referral to being assessed in the nurse-led clinic was 3.6 months. A total of 30 patients were discharged from the service based upon satisfactory radiological and biochemistry evaluation. A further 12 were diverted into a consultant-led clinic due to biochemistry findings (n=9), radiological findings (n=2) or being transferred to a different Health Board (n=1). A further 26 patients are currently under ongoing assessment with the service (awaiting biochemistry results only (n=5), waiting repeat CT only (n=2) and repeat CT and biochemistry (n=19)). Therefore, 30/42 (71%) patients having completed the nurse-led evaluation have been discharged from the service. 18/30 (60%) were seen only in one clinic and 12/30 (40%) seen twice before discharge. The mean time from the first contact with the nurse and discharge from the service was 5.7 months. It is estimated that this service has saved a total of around £40 000 so far (2 CT scans (each £200), 4 annual biochemistry assessments (each £72.83) and 4 annual appointments (each £160) for 30 patients).
Conclusions: A nurse-led service is an efficient and cost-saving method to manage AI in secondary care setting.