Use of Clinical Nurse Specialists in the Management of Incidental Pulmonary Nodules

Background: Pulmonary nodules are a common finding and national guidelines allow for a protocol led service that can be run by Clinical Nurse Specialists (CNS). Patients were identified at the point of triage as suitable for the CNS clinic, nodule characteristics identified which allowed the calculation of the Brock malignancy probability score, and time to next scan determined. Patients were then sent an information leaflet, followed by a telephone consultation with a CNS who took details of symptoms, performance status, and MRC dyspnoea score. Standardised clinic letters which included all the necessary clinical information ensured a uniform approach. Methods: Patients referred from Aug (when the service was started) to Nov 2020 were identified. Time from referral to appointment was determined, and compared with the wait for a Physician appointment. All records were also checked to determine if any patients were subsequently re-referred back to the respiratory service. Results: 115 patients were seen in the CNS pulmonary nodule clinic during the reference period. Median time from referral to appointment was 2 weeks, compared to over 12 weeks for a Physician appointment. Of the 115 patients, 6 were re-referred for a Physician appointment, but of those only 1 actually needed to be seen in a physician clinic, the others being managed with advice from the administration team. Conclusion: CNS nodule clinics are a satisfactory alternative to Physician clinics, with shorter waiting times and a high level of patient satisfaction. In our hospital there is the potential to save over 340 new Physician appointments per year which will go some way to mitigating the negative effects of the recent pandemic.