Barriers to immediate corticosteroid treatment in suspected giant cell arteritis with visual symptoms: insights from a tertiary eye care unit.

BACKGROUND: Visual symptoms in Giant cell arteritis (GCA) represent a sight-threatening condition; immediate treatment with systemic corticosteroids is important. Treatment delays may occur due to several issues such as diagnostic uncertainty, unfamiliarity with managing the condition or logistical medication issues. Current literature has not assessed local factors that might impact timely management of suspected GCA patients with visual features; we explored this and created an innovative infographic to enhance current practice. METHODS: Following an index case, we formed a multi-disciplinary working group to improve current practice. We started with an online questionnaire assessing the confidence and practice of our emergency eye care (EEC) team managing suspected GCA patients presenting with visual symptoms. Responses were collected over 4 weeks. RESULTS: We obtained valid responses from 41 out of 53 EEC staff. Most respondents felt confident taking a history (mean self-rating 4.3/5, CI: 4.0-4.6) and knowing investigations for GCA with visual loss (mean 4.0/5, CI: 3.7–4.3). However, participants were less confident liaising with rheumatology colleagues out of hours (mean 2.7/5, CI: 2.2–3.2). While 37.5% (n = 15) of respondents thought they knew the pharmacy team’s working hours, only one person was able to specify these correctly. We used information from the survey to design a novel GCA infographic, incorporating British Society of Rheumatology (BSR) 2020 and European Alliance of Associations for Rheumatology (EULAR) 2018 guidelines. We displayed the infographic in EEC and provided teaching to EEC staff to address the issues that we found. CONCLUSIONS: This novel study has identified local factors that negatively impact immediate management of suspected GCA patients in EEC and designed an infographic to support clinical decision-making. Data from other centres and further evaluation of this approach is needed to assess its impact on practice.