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Clinic cuts wait times for diagnosis and prevents future hospital admissions

Two women and a man standing on a patch of grass

21/09/2022

A new community clinic is helping to diagnose people with lung conditions quickly and will prevent hospital admissions in future.

The clinic determines whether they have a lung condition by using a spirometry device to measure how much air they can breathe out in one forced breath.

It is the only way to accurately diagnose chronic obstructive pulmonary disease (COPD), a group of lung conditions that can cause breathing difficulties.

Pictured above: Deputy practice manager at Gowerton Medical Centre, Nicola Smith, Dr Kannan Muthuvairavan, and respiratory specialist nurse Rebecca Bevan.

The spirometry clinic was initially trialled in GP practices within the Penclawdd and Gowerton areas of Swansea.

Now all GP practices across Swansea Bay can refer anyone with suspected COPD to the clinic for diagnostic testing.

This has proven extremely successful by ensuring quality, timely and effective care for people who need this investigation.

Dr Kannan Muthuvairavan, based at Estuary Group Practice, said: “During the pandemic, due to infection control and patients not being able to enter the building, advice came out nationally that spirometry should be stopped.

“Unfortunately, this led to a backlog of people unable to be diagnosed with COPD.

“As the Covid restrictions eased off a bit we tried to restart it but there were still infection control measures in place.

“This meant if you had done a spirometry test you would have to let the air recirculate for 30 minutes afterwards. So we could only use the room for one patient an hour.

“We knew there was a backlog of close to 800 patients in the community and I was thinking of ways to do this quickly, while not putting any of our patients or staff at risk.”

It was decided to launch the clinic on weekends, as more rooms at the surgery would be available, meaning more patients could be seen while still adhering to the infection prevention and control measures.

“We came up with the idea of doing this on the weekends when there was no-one else in the surgery,” Dr Muthuvairavan added.

“We can see a patient in a room and then we go to the next patient in the next room so that way with 15 minute slots we’d be able to complete four in an hour rather than one in an hour.

“We carried out risk assessments so our respiratory specialist nurse would wear PPE, there would be a screen in place and patients would have carried out a lateral flow test.

“Since November we have seen 767 people and we have identified 245 new COPD patients.

“It is important to diagnose COPD and prescribe the correct medication as early as possible as it can cause a lot of hospital admissions.

“We need this service to diagnose them or else we won’t be able to treat them appropriately.”

A man and two women wearing masks inside a GP surgery

To be diagnosed with COPD, a specific reading has to be displayed during the spirometry test, which helps to rule out other conditions such as asthma or a chest infection.

Patients with COPD are prescribed specific inhalers to help make breathing easier for them.

Dr Muthuvairavan said that the clinic provided people with quicker access to a spirometry test and allowed them to be diagnosed and treated closer to home, rather than in a hospital.

The spirometry clinic has even received national praise from Act on COPD, a disease education and healthcare transformation programme.

Dr Muthuvairavan said: “With these patients, if you don’t treat them appropriately, almost all of them will need to be admitted to hospital at some point.

“A COPD exacerbation - a worsening or flare-up of symptoms - can be as serious as a heart attack. We refer to it as a lung attack.

“Had they not been diagnosed, around half of the people we tested would have ended up in hospital beds. The remaining 50 per cent would have gone to the Emergency Department or their GP, so this clinic prevents that.”

Dr Anjula Mehta, Associate Medical Director for Primary Care, Community and Therapies Service Group, said: “The spirometry programme is something to be very proud of.

“It is an example of healthcare innovation in the heart of the community and brings the service to the patient to ensure timely diagnosis and optimisation.

“I am very thankful to the team for implementing this at such pace and leading the way for wider rollout.”

Mark Hackett, Swansea Bay CEO, said: “The development of primary care spirometry services is some of the first in the UK and is an excellent example of how thinking differently about service design can improve clinical effectiveness for patients and I am sure they’re accurately diagnosed and treated with the appropriate medication.

“I wish to commend our primary care colleagues for demonstrating the commitment, responsibility and initiative in this significant change for patients, which will also aid hard-pressed secondary care services.

“These type of developments are the ones that we wish to see to add an extended scope and pace across the health board to link to our Changing for the Future strategy.”

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