By Creselda Bagtas, Waqar Rashid, Arani Nitkunan
Department of Neurology, Croydon University Hospital, London

MS Foundation MasterClass 7, 2019


Introduction 

Croydon is one of the biggest and most populous borough in London1. An MS service was only introduced in Croydon in November 2018 with the appointment of a MS nurse specialist and MS consultant.  One of the most common cause of neurological disease admissions is multiple sclerosis2. Croydon CCG funded a new MS nurse specialist post to reduce the rate of admissions and length of stay of patients with MS. The RightCare data2 showed that this was higher in Croydon than other demographically matched CCGs. 


Objectives

This audit aims to analyse ED and IP data admissions in 2018 and determine the following:

  • A& E admissions and Inpatient unplanned admissions
  • Average length of stay in Inpatient admissions
  • Number of multiple admissions in Inpatient and ED
  • Primary causes of unplanned inpatient admissions in Ms patients

Method

An audit of patients with Multiple Sclerosis as Primary or Secondary Diagnosis was gathered from January 2018 to December 2018 from the hospital coding. The data gathered included ED attendances, unplanned inpatient admissions, length of stay, average length of stay and number of multiple admissions. The primary causes of MS patient admission were also tabulated.


Results:

Table 1

Age Distribution of Inpatient Admissions
children: 0-163
young adults 17-3010
middle aged 31-4528
old adults above 45160

Table 2

Age Distribution ED Admissions
children: 0-163
young adults 17-307
middle aged 31-455
old adults above 459

Table 1 and 2 shows that most patients who are admitted in ED and as inpatients are old adults (ages 45 and above).

Graph 1

Table 3

CriteriaAverage
A+E Attendances2
Unplanned Admissions17
Total Length of Stay124
Average Length of Stay7
Total No. Patients with Multiple Admissions1
No. Admissions of Patients with Multiple Admissions1

Graph 1 and Table 3 shows the summarised data of patients’ admissions. In 2018, the average number of unplanned the admission is 17 while the average length of stay is 7. Average ED attendances per month is 2.

Graph 2 

Graph 2 shows that the most common cause of admissions come from infections.


Conclusion

In 2018, the average number of MS patients with unplanned admission is 17. Average length of stay is 7 which, is higher compared to other London boroughs basing from the RightCare data in 20162.

The most common cause of admission is infection (65%) where 21% comes from UTI.

We have started to implement some actions to reduce inpatient admissions and length of stay. The MS nurse will review MS patients in the ward and will do a telephone follow up 2 weeks post admission. We will also utilise the urine infection leaflet from the occupational Therapy team well as referral to continence team for patient who have bladder symptoms. When urine infection is suspected, we will do a urine dipstick in the outpatient clinic. 

 We hope to repeat this audit to see if the above has helped our patient cohort.


Urine infection leaflet from OT team


References:

  1. 2017 Annual Report of the Director of Public Health. www.croydon.gov.uk/sites/default/files/articles/downloads/Annual_Public_Health_Report_2017.pdf.
  2. RightCare for Neurological Conditions. www.londonscn.nhs.uk/wp-content/uploads/2016/11/neuro-right-care-event-112016.pdf.
Bagtas-poster-MS7.2-Sept-2019