In a blog post for the Trust, Clinical Lead for Rheumatology Dr Louise Daniels writes how Rheumatology rose to the challenge running services during Covid-19.

The impact of the COVID-19 pandemic on our patients and staff has been phenomenal; and more importantly our patients and staff have been phenomenal in how they have coped during the pandemic.

Prior the pandemic we were all incredibly busy caring for our patients, but were not without our challenges. Like many other departments we had staffing shortages, contributing to growing waiting lists and delays.

As the threat of COVID-19 escalated our department responded rapidly and productively. In advance of being re-deployed we undertook an exercise to risk assess all of our existing patients (approximately 10 000). Those at highest risk were advised to shield. We also identified patients with very active disease who would need review in emergency telephone clinics.

 We wrote to all of our patients to explain that we would not be running any routine clinics during the pandemic.  We advised them on their treatment (in general terms), blood testing and how to contact us if they were having any problems (disease flare, side effects, prescription issues).  We updated the advice line message to give advice specific to the COVID pandemic.

We set up a specialist blood service for the most vulnerable patients to have their bloods taken in a protected environment.

During the pandemic the vast majority of our staff were re-deployed. Many of our nurses went bravely to the wards to care for extremely unwell patients. Some were able to use their skills and experience of dealing with Rheumatology drugs to contribute to valuable COVID research.

Our Rheumatology pharmacist returned to his previous role in the Intensive Care Unit. Our junior doctors and consultants joined the COVID rota, working in unfamiliar environments, forming bonds with new colleagues, re-learning forgotten skills and juggling the demands of life with new rotas and work patterns. 

Fortunately a few of our nurses and doctors were able to remain in the department or work from home whilst shielding and continue to care for our Rheumatology patients. Throughout the pandemic they worked tirelessly to deliver essential services and urgent care. 

They were able to maintain operation of a daily advice line, provide rapid response to advice and guidance requests from GPs, same day review of ward referrals and emergency telephone appointments.

Our biologic infusion service was able to continue by relocating to Spire Hartswood, urgent intramuscular steroid and joint injections were delivered, repeat prescriptions were issued and results continued to be monitored and communicated to patients and GPs. 

Our administrative and reception staff took on new roles and responsibilities, including calling patients whose appointments had been cancelled and cleaning clinic rooms and waiting areas to support the emergency clinics. Our patient pathway coordinators adapted to new ways of working and letter turnaround times are now extremely rapid.

Throughout these changes our staff and department have been supported by the management team working closely with us at all times. Despite the pressures of the pandemic we have been able to make some incredible service improvements, enabling us to begin to tackle some of our longstanding challenges.

During the pandemic, we conducted telephone reviews of patients on the waiting list. Some patients were able to be discharged with advice or treatment; others were scheduled for a face to face appointment once this was possible.

As our staff began to be released from the wards – we have been able to run more outpatient clinics, within the limitations required for infection control measures and social distancing. In order to continue to safeguard our existing patients, many of whom are immunosuppressed, we have not yet recommenced their routine clinics; but continue to offer them urgent telephone or face to face appointments as and when they need these.

 We have therefore been able to convert all the face to face clinics to new patient appointments to enable us to begin to clear the waiting list. We are also working closely with our local GPs and CCGs to introduce new pathways in order to manage referrals and waiting list issues in the longer term.

During the pandemic we have managed to clear the waiting list for patients awaiting a biologic treatment; these patients now have no treatment delay once tests are complete and it is considered safe for them to start treatment.

I am immensely proud of the Rheumatology team effort which has gone into dealing with the crisis of the COVID pandemic and working to safeguard our Rheumatology patients from the impact of this. The flexibility of the team to deal with uncertainties and changing demands has been inspirational.

Dr Louise Daniels
Clinical Lead for Rheumatology
Barking, Havering and Redbridge University Hospitals NHS Trust

Notes:

Dr Daniels has been working as a substantive Rheumatology Consultant for Barking, Havering and Redbridge University Hospitals since April 2013 and has been the Clinical Lead for Rheumatology since February 2017. 

The BHRUT Rheumatology department delivers a high quality service and in the 2019 National Early Inflammatory Arthritis Audit was ranked as the top performing London Trust (14th highest Nationally) in the achievement of reviewing suspected Early Inflammatory Arthritis patients within 3 weeks of referral (NICE Quality Standard).

Dr Daniels main subspecialty interests are inflammatory arthritis, seronegative spondyloarthropathies and connective tissue disease. 

Dr Daniels takes an active role in education and is the Educational Supervisor for the BHRUT Rheumatology trainee.