E027 Quality improvement in early inflammatory arthritis: implementing NICE QS33 Standards

Abstract Background/Aims Early inflammatory arthritis (EIA) requires rapid diagnosis and treatment to prevent long-term disability. NICE Quality Standard (QS33) suggests rheumatology review within 3 weeks of referral, initiation of DMARDs within 6 weeks of diagnosis, DAS-28 monitoring, and a treat-to-target approach as part of the EIA pathway. The aim of our QI project was to ensure that 80% of patients receive timely rheumatology review, DMARD initiation, and DAS28 monitoring within one year through the implementation of a structured EIA pathway in the Rheumatology Department at Southend University Hospital, UK. Methods After the baseline audit (Jan-Jun 2023), an EIA pathway was introduced in our department to improve and streamline patient care. Regular training sessions for clinicians and multidisciplinary team meetings were held, and a reaudit was done between Jan-Jun 2024 to assess the service delivery. Key outcome measures based on NICE QS33 standards were analysed. Results The patient cohort for both years consisted of 138 patients, of which 29 were diagnosed with rheumatoid arthritis. The proportion of patients reviewed in the rheumatology department within 3 weeks of referral increased from 27% to 79% after implementation of the EIA pathway, as summarised in Table 1. Initiation of DMARDs within 6 weeks improved from 44% to 75%. DAS-28 measurements at baseline and at 6 months improved from 75% to 89.6% and 60.7% to 96.5%, respectively. Mean follow-up visits per patient during the first 6 months increased from 2.8 to 3.4. The implementation of the EIA pathway at our centre has shown a significant improvement in service delivery and reduction in referral to review delays, and improved adherence to objective EIA monitoring tools such as DAS-28. Initiation of biologics (advanced therapy) was not significant but may suggest improved identification of patients with suboptimal DMARD response. Conclusion Implementation of the EIA pathway produced measurable improvement across all NICE QS33 standards. Timely review, faster DMARD initiation, improved DAS28 monitoring, and better follow-up continuity demonstrate enhanced quality of care. Standardised care pathways such as EIA pathway and regular clinician engagement enhance patient outcomes and clinical efficiency. Patient education plays a crucial role and, although not formally measured, remains an important determinant of optimal early arthritis care. Alt text: The image depicts a table showing the impact of the early inflammatory arthritis pathway on key outcome measures, as well as a visual overview of the pathway. Disclosure D. Ramachandran: None. K. Garg: None. L. Manokaran: None. S. Sankar: None. A. Sidhu: None.