E014 Attacked by all sides or shooting ourselves in the foot - can we control a nurse-led telephone helpline?

Background/Aims Urgent patient access to rheumatology services is encouraged by current guidelines. By definition, this is unpredictable work, and for those managing helplines, it can feel disempowering and at times overwhelming. Our rheumatology service has a catchment area of 745,000, and we have 3.8 WTE Clinical Nurse Specialists (CNS) - two of whom are prescribers. Our telephone helpline runs Monday to Thursday, and messages are picked up once a day. An email service is also available 24/7. Calls are responded to within 72 hours. We aimed to analyse the content and number of telephone helpline messages to help manage demand. Methods Data from our departmental spreadsheet and Cerner EPR were collected during December 2024 (16 helpline days). Results Over one month, there were 125 phone calls (equivalent to 7.8 per day) and 819 emails (52 per day). In 85 out of 125 phone calls, a plan was documented in the EPR. The other calls were documented in a spreadsheet. Documentation was missing in 10. In 10 (8%) cases, a letter was generated to the GP. 75 (60%) calls were from RA patients, 12 osteoporosis, 7 PsA, 7 AS, 5 CTD, 2 fibromyalgia, 17 other. The commonest reason to call was to request a repeat DMARD prescription (23%), then to report a flare (22%), followed by requesting a repeat biologic prescription (15%). Other issues included advice if unwell, i.e. infection (7%), reporting drug side-effects (5%), questions about advised dosing regimes (4%), advice re having an operation (3%), blood test form requests (4%), and results queries (6%). In 37 (30%), clinical advice was given by a nurse; 13% by a consultant; 5% by a registrar. For 5 patients (4%), the call resulted in an OPD appt. Conclusion Over 16 days, there were 125 phone calls and 819 emails. Service contacts are now predominantly via email rather than telephone helpline. The CNS team gave clinical advice to 30% of callers. The number of calls related to DMARD and biologic prescriptions indicates that there is a lack of planned capacity to deal with these, and will inform service change. Flares (22% of calls) are unpredictable, and it is important to assess patients promptly. As digital access to health care teams continues to increase, departmental secretarial services are reduced, and consultant work is increasingly delegated to AHPs, the CNS team are under increasing pressure - ‘shot from all sides’. We need to monitor helpline services (both email and telephone) to ensure we have planned services to meet changing demands. This involves looking at administrative systems, clinic capacity, and novel ways to help with increasing patient contacts via email, such as AI tools. Disclosure D. Thomas: None. S.M. Griffith: Honoraria; UCB.