E155 Should general practitioners refer patients for temporal artery ultrasound scans?

Abstract Background/Aims As part of a root and branch review of the management of giant cell arteritis (GCA) in our locality, we worked towards reducing our glucocorticoid start to temporal/axillary artery vascular ultrasound time across the health economy in order to improve diagnostic confidence. Some fast-track GCA pathways are one-stop clinics. Others are not, due to the centralisation of many services, variations in the mode of service provision and different points of patient access to care. In our locality, vascular ultrasound is in a different healthcare setting to the rheumatology clinic. A referral proforma was created to refer patients with possible GCA presenting to primary care simultaneously to ultrasound scan (straight to test) and to rheumatology, aiming to optimise the glucocorticoid to scan time. Methods Patients referred for temporal/axillary artery vascular ultrasound via the new pathway from 1/1/25 to 30/6/25 were identified. Those referred from primary care to rheumatology were included in the audit. The diagnostic pick-up rate of vascular ultrasound scan diminishes rapidly over time after initiation of glucocorticoids and this imaging should ideally be done within one week of starting glucocorticoids (the audit standard). The glucocorticoid start to scan time for patients referred using the referral proforma was compared to those where the proforma was not used. Results 73 patients were referred for temporal/axillary artery vascular ultrasound during these six months. 16 patients were referred directly from primary care to scan using the proforma and simultaneously referred to rheumatology. 2 of these 16 were excluded as the rheumatology referral was cancelled or delayed due to evolving symptoms. Of these 14, 9 were referred using the referral proforma and 5 were not. The mean referral to scan time for the 9 proforma patients was 5.67 days (range 2-9 days) compared to a referral to scan time for non-proforma patients of 14 days (range 9-20 days). The remaining 57 patients were in-patients referred directly from ophthalmology, existing rheumatology patients, or referred from acute medicine. Conclusion This audit shows that straight to test can be an effective method of optimising glucocorticoid start to temporal/axillary artery vascular ultrasound time in the setting of possible GCA presenting to primary care, where the ultrasound and rheumatology teams are on separate sites, or there is no provision for a one stop clinic. The results are a snapshot of the first six months of a new pathway. It required collaborative working with primary care. As confidence and familiarity with the pathway increase, it is hoped that proforma utilisation will increase. Disclosure A. Paul: None.