PTU-095 Front door presentation with iron deficiency anaemia management pathway

Introduction This project aimed to improve the care of patients presenting via their general practitioner (GP) or emergency department (ED) with new iron deficiency anaemia (IDA) by reducing unnecessary blood transfusions; reducing unnecessary admissions for blood transfusion; arrange iron infusions in the ambulatory care ward (ACW) and streamline investigations. Methods An audit between 7th March and 7th April 2016 identified 28 patients who were admitted and had blood transfusions, 9 of these could have potentially been managed in ambulatory care with an iron infusion. 6 patients had blood in the ambulatory care ward receiving 14 units in total. Pathology started to automatically test B12, folate and ferritin in all blood tests from ED and GPs with new potential IDA. A pathway for ED and GPs was set up to enable patients to be booked into ACW for iron infusions, or given oral iron, rather than admitted to medical assessment (MAU) for blood transfusion. Criteria for further investigaiton were set. A costing estimate was developed for the cost of the iron infusion vs blood transfusion; including nursing time and consumables. Training was delivered to the ambulatory care nursing staff in administration of iron infusions and a pathway developed with pharmacy to ensure timely delivery of the iron infusion. Results The project was launched on 1 st August 2016. Over 12 months to 31 st July 2017, 65 patients, median age 70 (23–91) years, received an iron infusion in ACW. Median Hb 75 (40–130) g/dl, follow up Hb median 112 (75–155) g/dl a median of 34 (1–133) days post iron infusion. 10 patients additionally received blood, median 2 (1–6) units. There was an overall reduction in units of blood transfused in MAU from 841 to 552 comprising of mostly of a reduction in ACW units transfused from 768 to 319. There were 15 new diagnoses as a direct result of the incident presentation, 7 cancer, 7 non- cancer gastric ulcers and 1 recurrent metastatic ovarian cancer. There was an established diagnosis in 21 patients, 6 cancers and 13 non-cancer of which 6 were gastrointestinal causes. In 28 patients, no diagnosis was made. In 10 patients investigations were normal. In 9 patients it was decided they were not for appropriate for further investigation. 4 were not iron deficient, 4 had an unknown outcome and 1 patient was pregnant 2 months post iron infusion and not investigated further. Conclusions This was the sucessful development and implementation of a pathway to streamline the care of patients presenting acutely with IDA. There has been a reduction in the number of units of blood transfused in MAU and a 58% reduction in the number of units of blood transfused in ACW. 65 patients have been treated with an iron infusion with an overall improvement in their Hb, with 23% receiving significant new diagnosis.