E-Poster Presentation ESA-SRB-ANZBMS 2021

Background

The Royal Melbourne Hospital (RMH) is a tertiary/quaternary centre for the management of adult endocrine and pituitary diseases. Until May 2021, endocrine dynamic investigations have been coordinated by the Endocrine registrars, however increasing demand for dynamic investigations, and competing clinical commitments for the registrars was limiting availability of these tests. Therefore, in May 2021 we implemented measures to optimise dynamic investigations including:

•  Training an Endocrine Grade 4b Registered Nurse to perform and coordinate reporting of dynamic investigations (0.4 FTE).
•  Formalising protocols for dynamic investigations
•  Formalising presentations of dynamic investigation data by the Endocrine registrar to 2 Endocrinologists at a fortnightly meeting.

Aim

To determine if Endocrine nurse led endocrine dynamic investigations improve patient outcomes at RMH.

Methods

Dynamic investigations performed between May-July 2021 were compared to the corresponding period in 2020. Outcomes measured included: number of dynamic investigations performed and resultant treatment changes. Baseline and 3-month satisfaction scores for Endocrinology registrars were also assessed (completely dissatisfied (1)-completely satisfied (5)).

Results

At baseline (May-July 2020), 9 dynamic tests were performed including 3 glucagon stimulation tests (GSTs) and 1 adrenal vein sampling procedure (AVS) (Table 1). Two patients had adult growth hormone deficiency (AGHD) and one commenced GH replacement. The patient who had AVS was managed medically. Following intervention (May-July 2021), 21 dynamic tests were performed, including 9 GSTs and 3 AVS. Seven had AGHD; Four received GH treatment education from the endocrine nurse, two have planned education and one was enrolled in a GH clinical trial. Three AVS procedures demonstrated unilateral primary hyperaldosteronism in two patients, who were referred for adrenalectomy. Staff satisfaction improved from 2/5 to 4/5.

Conclusions

Endocrine nurse led dynamic investigations have improved testing rates, treatment and staff satisfaction. Ongoing funding for an Endocrine nurse is paramount for providing optimal care for patients with pituitary disease.