Background
Royal Melbourne Hospital (RMH) is a quaternary centre for management of adult pituitary disease. Growth hormone (GH) replacement is now available on the PBS, however GH commencement is resource intensive: screening for eligible patients, performing a GH stimulation test, completing the QoL-AGHDA questionnaire and educating patients about treatment. Historically, this has been coordinated by the Endocrinology registrars. In May 2021, we introduced an Endocrine nurse initiative to improve the detection and management of adult GH deficiency (AGHD). The initiative consisted of appointing and training an Endocrine Grade 4b RN to screen our Pituitary Database for potential patients, coordinate GH stimulation testing and provide GH treatment education.
Aim
To determine if an Endocrine nurse initiative improves the detection and management of AGHD at RMH.
Methods
We audited the number of GH stimulation tests performed and the number of patients diagnosed with AGHD who commenced GH therapy from May-July 2021 compared with the same period in 2020. Baseline and 3-month process satisfaction scores for Endocrinology registrars were also assessed (completely dissatisfied (1)-completely satisfied (5))
Results
At baseline (May-July 2020), 3 glucagon stimulation tests (GSTs) were performed and 2 patients had AGHD; one commenced GH therapy. After introduction of the Endocrine nurse (May-July 2021), 9 GSTs were performed and 7 had AGHD. Four patients received GH treatment education from the endocrine nurse, 2 have upcoming education appointments and 1 was enrolled in a GH clinical trial. The introduction of the Endocrine nurse improved satisfaction scores for the Endocrine Registrars from 2/5 at baseline to 4/5 at 3 months.
Conclusions
The introduction of an Endocrine nurse to improve the detection and management of AGHD has improved rates of testing, diagnosis, treatment and staff satisfaction. Ongoing funding for an Endocrine nurse is paramount for providing quaternary level care for patients with pituitary disease.