Endocrine Abstracts

Background: For patients in an adrenal crisis, the timely administration of parenteral hydrocortisone can be life-saving. Data from the Addison’s Disease Self-Help Group found that a large proportion of adrenal crises occur out of hospital, with many patients relying on the emergency services for initial parenteral hydrocortisone administration. Despite regular patient education (including parenteral hydrocortisone self-administration) and recommendations to wear steroid alert jewellery or carry steroid alert cards, it is not uncommon for patients with primary or secondary adrenal insufficiency to experience delays in the administration of potentially life-saving hydrocortisone injections when unwell often due to health care services being unaware of their diagnosis.

Aim: The aim of this project was to identify the current local rates of emergency attendance of steroid-dependent patients and the rates of pre-hospital parenteral hydrocortisone administration to help guide service-development.

Methods: STHK is a large secondary care hospital in the North West of England with over 800 beds and up to 450 emergency department presentations per day. A list of steroid-dependant patients was obtained from the endocrine outpatient department, and using the hospital electronic records a search was performed on all hospital attendances over the 3-year audit period (2015–2018). Following collection of this data, we worked extensively with our local information governance team and North West Ambulance Service NHS Trust (NWAS) to set up a data-sharing agreement for patients with adrenal insufficiency. Following patient consent, we securely upload patient details to the NWAS Electronic Referral and Information Sharing System (ERISS).

Results and Outcomes: More than 50% of our steroid-dependent patients attended hospital as an emergency within the time period. 78% of patients arriving by ambulance did not receive pre-hospital parenteral hydrocortisone. 56% of patients arriving by ambulance did not receive parenteral hydrocortisone upon attendance to AED. With the ERISS upload and through collaboration with NWAS, following a 999 call, NWAS paramedics and call-handlers are automatically notified that the patient involved requires parenteral hydrocortisone upon emergency service contact.

Conclusions: For patients with adrenal insufficiency, a delay in parenteral hydrocortisone in an emergency can be fatal. A high proportion of steroid-dependent patients within the St Helens and Knowsley region do not receive parenteral hydrocortisone in a timely fashion when becoming significantly unwell. Through an information-sharing arrangement with the ambulance service, we have set up this safety net to ensure that no patient of ours with adrenal insufficiency misses out on this potentially life-saving treatment during an ambulance-callout.