Background: Endocrinology clinical nurse roles are not established in many metropolitan hospitals in Australia. The Royal Melbourne Hospital (RMH) is a quaternary centre managing adult endocrine and pituitary diseases which until recently has not had access to an Endocrinology nurse to assist with coordinating endocrine dynamic investigations. In May 2021, new measures were implemented to optimise dynamic investigations. These included training an Endocrine Grade 4b Registered Nurse to perform and coordinate dynamic investigations (0.4 FTE), formalising protocols for dynamic investigations, and formalising presentations of dynamic investigation data by the Endocrinology registrar to two Endocrinologists at a fortnightly meeting.
Aim: To determine if a revised model of care of endocrine dynamic investigations incorporating an Endocrinology nurse improves patient outcomes.
Methods: We audited the number of endocrine dynamic investigations performed at baseline (May 2020 - April 2021) compared with following intervention (May 2021 – April 2022).
Results: At baseline, 37 dynamic tests were performed including 10 glucagon stimulation tests (GSTs) and 6 adrenal vein sampling procedures (AVS). Seven patients had adult growth hormone deficiency (AGHD) and five commenced growth hormone (GH) replacement. Following AVS, 2 did not lateralise and were medically managed. 4 lateralised, with 3 patients undergoing successful adrenalectomy with 1 waiting for adrenalectomy. Following intervention, 76 dynamic tests were performed, including 32 GSTs and 11 AVS. 26 had AGHD; 13 received GH treatment education from the endocrine nurse, and 2 were enrolled in a GH clinical trial. Following AVS, 4 did not lateralise and were medically managed. 6 lateralised, with 4 patients undergoing successful adrenalectomy and 2 patients waiting for adrenalectomy.
Conclusion: Following the institution of an Endocrinology nurse, dynamic investigations performed doubled with improved hormonal treatment initiation and staff satisfaction. This experience may be of value to hospitals which are seeking to justify funding of an Endocrinology nurse role.