Research by Pauline McDonald, MS specialist nurse

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them. 

This snapshot, awarded ‘runner up’ in the MS8 project awards, gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot. 

If you would like to contact the alumni who did the research, drop us a line and we’ll put you in touch where possible.

Aim

To discover the length of time it took from diagnosis of MS to starting treatment, to identify the delays along this pathway and to review ways to modify practice to reduce those delays.  

Particular areas of interest included: 

  • what effect a delay in nurse contact has on patients beginning a disease modifying treatment (DMT). 
  • the effectiveness of referrals arriving by email. 

Headlines

  • Data was gathered through a retrospective case note analysis of people with MS who attended the nurse led clinic from July – September. 
    • Only newly diagnosed patients eligible for a DMT were included. 
    • How many referrals were made by email and length of time from diagnosis to the nurse making contact with the patient were recorded.  
  • The current pathway was analysed, calculating time taken for:
    •  the referral to be made, 
    • to reach the nursing staff, 
    • for nursing staff to act on the referral, and 
    • for the patient to start on treatment after their diagnosis (start dates were not recorded so date of prescription was taken).
  • Reasons for delays that affected patients who had waited longer than 1 month for treatment were documented and common themes examined.

Key findings

  • Delays were predominantly due to referral letters being delayed, typed and going through the postal system to the nursing staff. Lengthier delays were due to staff absences such as holidays holding up letters being typed or signed off. 
  • 15 of the 37 people who attended the clinic were newly diagnosed and eligible for a DMT. One was referred by email, one was referred verbally; the remainder were referred by letter.
  • 12 (80%) were contacted by an MS nurse within 10 days of diagnosis, 2 (13%) were contacted between 10-20 days and 1 (7%) was contacted between 20-30 days.
  • The time taken for a referral to be made to the MS Nurse team was between 0 – 20 days. 9 of these referrals were within 5 days.
  • Following receipt of a referral the MS nurses made contact with the patient within 4 days, posting a letter with the services’ contact details.  (One patient’s referral never arrived, however the patient telephoned the nurse service 16 days after diagnosis.)

Changes to practice made

  • Revised referrals process (via email) was not working; only one person had been referred by email. This is being encouraged as the MS nurses can respond to a referral within 4 days email referrals make the standard of making contact with 10 days of diagnosis achievable.
  • Business cards with the MS nurse service  contact details on to give to patients in clinic have been made. Therefore, if the referral is delayed, perhaps for unavoidable reasons such as unexpected absence, the patient can make direct contact.
  • Although the MS nurses were responding to the referral within 4 days, patients were waiting to be seen in clinic. To ensure people are seen quickly in clinic to start on treatment the new patient clinic is now being used for people who are newly diagnosed starting treatment. 
    • People who are newly diagnosed and not starting on treatment are allocated a slot in one of the MS nurse follow up clinics.
  • Some delays are unavoidable, e.g. as patients wanting time to think about treatment options or further investigations being required for abnormal bloods.
  • Aside from this work, the hospital service has looked at the waiting times for an MS neurologist and these have been reduced to 7 weeks, reducing delays in diagnosis.

Core recommendations

  • Repeat this same audit in 3 months to establish any improvement
  • It would be helpful to look at the length of time it takes for the patient to start treatment after the prescription has been generated.  At the moment this all goes through a home care delivery company or the patient will be admitted to hospital as a day case and an exact start date is not recorded. This is being considered. 

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