Longitudinal single-centre study of the feasibility of implementation of best practice guidelines for relapsing MS and their impact on acute hospital utilisation

It is recommended that optimal care of persons with MS is in a specialist multi-disciplinary setting. Expert guidelines for the management of persons with MS have been recently developed.1,2 Little evidence exists as to whether implementing evidence based care recommendations is feasible in “real-world” MS clinics. Concern exists with regard to impact on acute hospital services with the development of large volume specialist MS services. We therefore undertook a single centre 4-year review of a tertiary MS service in light of consensus recommendations and undertook an analysis of acute hospital service utilisation.

Methods: Using multiple data sources (MSbase registry, electronic health record, ICD casemix) we undertook an analysis of guideline derived MS service outcomes encompassing service responsiveness (waiting times), acute hospital utilisation (Inpatient and ED utilisation), relapse management and immunotherapy uptake. Service workload was analysed.

Results: Flinders Medical Centre MS service activity in the years 2012-15 was analysed. The service workforce included one MS neurologist and two part-time MS nurses for the duration of the study. A junior clinical fellow joined in 2013. As of December 2015, 486 patients were registered with the service with a 40% increase from 2012-15. 327 (67%) had relapsing MS. Significant improvements in percentage of patients seen within target waiting times was seen across the study duration. By 2015 68.9% of all high triage priority patients were seen within consensus recommended times. No deleterious impact on acute hospital services (ED attendances, inpatient episodes or LOS) was observed. Only 24 patients with active relapsing MS were not on immunotherapy. Total immunotherapy uptake was 73%. Only 7% of acute/relapse reviews occurred in the ED (93% of acute/relapse occurred in the ambulatory setting). Despite accumulating 142 patients from 2012-15, no increase in ED or inpatient utilisation was seen. Health economic modelling using hospital costs saved was favourable. Service workload to achieve these outcomes by 2015 was high.

Summary: Achievement of consensus management guidelines outcomes based on waiting times, relapse management and immunotherapy uptake were met despite accumulation of high patient numbers relative to workforce size without corresponding impacts on acute hospital services.