Background: Endocrinology clinical nurse roles are not established in many metropolitan hospitals in Australia. The Royal Melbourne Hospital is a quaternary centre managing adult endocrine and pituitary diseases, including adult growth hormone deficiency (AGHD). Growth hormone (GH) replacement is now available on the pharmaceutical benefits scheme, however GH commencement is resource intensive: screening eligible patients, performing a GH stimulation test, completing the QoL-AGHDA questionnaire and educating patients about treatment. In May 2021, an endocrinology nurse initiative was implemented to optimise AGHD management. This included training an Endocrine Grade 4b Registered Nurse to screen our Pituitary Database for potential patients, coordinate GH stimulation testing and provide GH treatment education.
Aim: To determine if an Endocrinology nurse initiative improves the detection and management of AGHD and patient outcomes.
Methods: We audited the number of GH stimulation tests performed and the number of individuals diagnosed with AGHD who commenced GH therapy following intervention (May 2021 – April 2022) compared with at baseline (May 2020 – April 2021). Baseline and current satisfaction scores for Endocrinology registrars were also assessed (completed dissatisfied (1) – completely satisfied (5)).
Results: At baseline (May 2020 – April 2021), 10 glucagon stimulation tests (GSTs) were performed, and 7 patients had AGHD; 5 commenced GH therapy. After introduction of an Endocrinology nurse (May 2021 – April 2022), 32 GSTs were performed and 26 had AGHD. 13 were commenced on GH replacement therapy, with 2 individuals enrolled in a GH clinical trial. The introduction of an Endocrinology nurse improved satisfaction scores of the Endocrinology Registrars from 2/5 at baseline to 4/5.
Conclusion: Introduction of an Endocrinology nurse role to improve the detection and management of AGHD has improved rates of testing, diagnosis, treatment, and staff satisfaction. Ongoing funding for an Endocrinology nurse is paramount for providing quaternary level care for patients.