BSH2021-PO-115 The effect of an ambulatory care pathway on management of anaemia in a district general hospital

Published Date: 14th April 2021

Publication Authors: Bonney S

Abstract
The burden of iron deficiency anaemia (IDA) is reflected by the rising number of emergency admissions related to IDA and reports of the monumental cost of managing the condition as an inpatient. The National Health Service spends approximately £55 million per annum on IDA-related non-elective admissions, many of which could be preventable and managed in the community or ambulatory care setting.

In 2018, a retrospective data collection was performed to assess the overall management of 50 newly diagnosed cases of anaemia presenting to a district general hospital between May – July 2018. This data was compared to quality standards issued by the British Society of Gastroenterology and recommendations on blood transfusion as advised by the National Institute for Health and Care Excellence. An ambulatory anaemia pathway was created and implemented in 2018 with the aim of streamlining investigations for anaemia and establishing criteria for urgent referral and safe ambulation. A further 77 cases of anaemia presenting to secondary care between November and February 2019-2020 were assessed against the same quality standards used in the initial data collection and results compared.

74% cases with anaemia were appropriately investigated in 2019/2020 compared to 48% in 2018. Only 18% of the cohort with IDA had a urine dip performed and documented and 27% patients in this group did not have a coeliac screen in 2019/2020. Many patients received blood transfusions above haemoglobin thresholds recommended by NICE, however a modest increase of 17% patients in 2019/2020 had a haemoglobin review between units. Iron replacement in IDA improved from 59% to 73% in 2018 to 2019/2020, respectively. In 2019/2020 there was a 25% increase in the number of patients with a confirmed malignancy that were referred appropriately under a two-week wait compared to 2018. The proportion of patients that were clinically appropriate and subsequently ambulated was 75% and 73% in 2018 and 2019/20, respectively.

Although overall management of anaemia improved after the ambulatory anaemia pathway was implemented, basic investigations such as a urine dipstick and coeliac screen were not performed in several cases. Treatment of IDA was superior in 2019/2020, as there was an improvement in iron replacement and fewer patients were transfused multiple units of blood without review between units. A greater number of patients who were subsequently diagnosed with a malignancy had appropriate urgent follow-up in 2019/2020 compared to 2018. There was a marginal decline in the number of patients who were clinically appropriate for ambulatory care and were discharged, however these decisions are often complicated by complex medical and social factors.

As a result of national bed shortages following the COVID-19 pandemic, the requirement to reduce non-elective admissions and preserve blood products has never been more pressing. Therefore, it is proposed that the ambulatory anaemia pathway could help reduce non-elective admissions for anaemia by encouraging safe ambulation, avoid unnecessary blood transfusions and provide appropriate follow-up. It would be prudent to assess the impact of COVID-19 on hospital admissions with anaemia and determine whether ambulated patients demonstrate clinical improvement or require subsequent admissions for their symptoms of anaemia.

 

Mahapatra, P; Bonney, S; Cummings, P; Taylor, D. (2021). BSH2021-PO-115 The effect of an ambulatory care pathway on management of anaemia in a district general hospital. British Journal of Haematology. 193 (125)

« Back