Table 2

Quality of EIA service: quality indicators and criteria for scoring

Indicator
(NICEQS from 2013 guidance6)
Criteria for each score
210
Effectiveness of referral process
(NICE QS 2)
Standardised process with agreed criteria
(not too many/rigid)
Separate EIA referral daily triage
Referral to service with or without proforma
Complex criteria
Goes through double process through external booking platform
Letter/Non-template information
Non-direct referrals (eg, via CCG)
No triage or infrequent triage
Effectiveness of appointment booking process
(NICE QS 2)
Team control
Admin dedicated
EIA slots
Team control, but no dedicated admin
EIA slots but overbooked
Discrepancy in main and peripheral sites
Centralised admin/limitations on choose and book; no EIA dedicated slots
Waiting time for first appointment
(NICE QS 2)
Patients with suspected EIA are seen within 21 days of primary care referralPatients seen >3 but up to 6 weeks of primary care referralDelays over 6 weeks
First appointment qualitySufficient time for diagnosis and disease counselling
One stop shop
More than one doctor sharing EIA workload—team responsibility
Clinic shared across team, but diagnosis and treatment in same clinic slotTime limit—not shared appointments
EIA all on one doctor
Diagnosis and treatment all in one slot
Speed of diagnosis
(NICE QS 3)
Good access to diagnostics—bloods, ultrasound—within a weekVaried timings for blood/X-ray and ultrasounds
Having to wait for some results—not all on same day
2 weeks plus delays
Timeliness of DMARD initiation
(NICE QS 3)
Within 2 weeks consultant/nurse controlledMost at first appointment but some situations untimely appointmentsGP control
Quality of DMARD4 initiation
(NICE QS 4)
DMARD support (education) separate appointment/counsellingPrescription on day of diagnosis but nurse counselling 2–3 weeks laterPrescription on same day as diagnosis only
Typical follow-up appointment pattern
(NICE QS 5)
Systematic/Planned approach (with flex)
Monthly in person or on phone with doc or nurse review with consultant around 6 months; annual review
Nurse DMARD clinic
Inconsistencies in follow-up appointments
Good protocol but not followed due to insufficient staff capacity
Varied/Ad hoc appointments
Losing track of patients
Less nurse/more consultant involvement (relates to MDT)
Treat to target escalation decisions
(NICE QS 5)
Nurse involvement;
autonomy; protocol (consistently followed); timely decision
Nurse involvement with protocol but appointment delaysDelays due to lack of autonomy or lack of protocol/training
Process not supporting it to happen
Quality of patient education
(NICE QS 6)
Variety of approaches; integral to process; multiple timepoints; rapid accessibility (eg, helplines)Education only in appointments with nurses/doctors and allied health professionalsLack of structure-limited options
Ad hoc—relies on individual clinician input in appointments
Relies on patients being proactive
Support between appointmentsMultiple options-rapid accessibility-staffed well; get back within 24 hours
Patients are well informed of the options secretaries/admin support
Rapid access in clinics
Emergency slots available
Calls returned within 24–48 hours with no access to quick appointmentsPatients lack clarity regarding options
Limited options
Restricted hours
Not staffed well
Unable to prioritise answering calls
No mechanism for rapid assessment/treatment
  • CCG, Clinical Commissioning Group; DMARD, disease-modifying antirheumatic drug; EIA, early inflammatory arthritis; GP, general practitioner; MDT, multidisciplinary team; NICE, National Institute for Health and Care Excellence; QS, quality standard.