Quality statement 2: Assessment

Quality statement

People with suspected persistent synovitis are assessed in a rheumatology service within 3 weeks of referral.

Rationale

Rapid assessment in a rheumatology service is important to avoid delay in diagnosis and increase the likelihood of early treatment initiation. Given the potentially devastating effects of delayed diagnosis in terms of joint damage and quality of life, people with these symptoms and signs need to be assessed quickly.

Quality measure

Structure: Evidence of local arrangements for people with suspected persistent synovitis to be assessed in a rheumatology service within 3 weeks of referral.

Process: Proportion of people with suspected persistent synovitis who are assessed in a rheumatology service within 3 weeks of referral.

Numerator – the number of people in the denominator who are assessed in a rheumatology service within 3 weeks of referral.

Denominator – the number of people with suspected persistent synovitis referred to a rheumatology service.

What the quality statement means for each audience

Service providers ensure systems are in place for people with suspected persistent synovitis to be assessed in a rheumatology service within 3 weeks of referral.

Healthcare professionals ensure that people with suspected persistent synovitis are assessed in a rheumatology service within 3 weeks of referral.

Commissioners ensure they commission services that enable people with suspected persistent synovitis to be assessed in a rheumatology service within 3 weeks of referral.

People with suspected persistent synovitis (inflammation of the joints) are assessed in a rheumatology service within 3 weeks of referral.

Source guidance

NICE clinical guideline 79 recommendation 1.1.1.1 (key priority for implementation).

Data source

Structure: Local data collection.

Process: Local data collection. Contained within the British Society for Rheumatology National clinical audit for rheumatoid and early inflammatory arthritis and within the Commissioning for Quality in Rheumatoid Arthritis (CQRA) Patient metric data collection form for recent onset rheumatoid arthritis.

Definitions

Timeframe derived from expert consensus and is consistent with best practice (as defined in the 2013–14 best practice tariff for early inflammatory arthritis).

Symptoms and signs of persistent synovitis include persistent (not resolving within 3 or 4 weeks) pain, swelling, heat, early morning stiffness lasting more than 30 minutes and often recurring after longer periods of rest, and loss of function of the affected joint. Occasionally the joints may also be red, but this is unusual. The person may also have systemic symptoms of inflammation, which include malaise, fever, sweats, fatigue and weight loss.

A rheumatology service comprises a specialist multidisciplinary team, all of whom have expertise in managing rheumatoid arthritis. The team is led by 1 or more consultant rheumatologists and includes nurse specialists, physiotherapists, occupational therapists, podiatrists and orthotists. It has access to supporting specialties including orthopaedic surgery, psychology, radiology with rheumatological ultrasound and MRI experience, and may also have rheumatology doctors in training.