G533(P) Development and evaluation of standardised follow up pathway for henoch schoenlein purpura

ContextThe quality improvement involved development of a follow up service for patients presenting to a busy district general hospital with Henoch Schoelein Purpura (HSP). Follow up is recommended as the rare but important renal sequelae of the condition can be silent initially.ProblemIn our department no follow up pathway existed for HSP. Patients were seen in either consultant outpatient clinics, with the majority of children being well, or discharged for primary care follow up which relies on general practitioners and families to organise ill defined follow up creating the potential to miss any renal sequelaeAssessment of problem and analysis of its causesThe problem was identified during the acute assessment of patients presenting. Following discussion with senior staff about absence of evidence based local follow up procedures and subsequent literature review a structured pathway was proposed. It was felt that all children should have hospital review with consultant follow up focusing on children with complicationsInterventionThe aim was to standardise and rationalise care thereby improving department efficiency without compromising patient safety. A pathway for nurse led follow up which had been piloted elsewhere (1) was used as a model. Children were assessed at presentation and guidance was given for those needing admission or investigation. Otherwise they should be discharged home with urine dipsticks to check early morning urine and information about what concerning features should lead them to seek reassessment. All children were seen seven days later and stratified according to absence or presence of proteinuria, as a marker for renal involvement, to standard follow up (four in the year) and more frequent visits (seven in the year) if proteinuria present. If proteinuria developed in the standard group, they moved to more frequent follow up. Urinalysis was undertaken at each follow up visit and criteria for consultant review were clearly defined.(1) Henoch Schonlein Purpura - A 5-Year Review and Proposed Pathway. Louise Watson, et alStrategy for changeDuring the development stage senior nursing and medical staff were consulted about the practicalities and possibilities of developing a similar pathway and a guideline was produced with department ratification. Only limited information about the pathway was disseminated to junior staff before its introduction.Measurement of improvementSixteen months on, an audit and service evaluation was undertake