A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

Wood, Laurence; Hendrick, Paul; Boszczyk, Bronek M.; Dunstan, Eleanor

doi:10.1308/rcsann.2016.0054

Cited by 28 publications

(35 citation statements)

References 14 publications

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“…The findings of this service evaluation show that the majority of patients (75%) directed to the MAC were independently managed by the CSPs without review by the rheumatology consultant or team. This is comparable to the findings of similar orthopedic service evaluations , which have reported that 50%‐92% of patients seen in physiotherapist‐led triage services were managed without referral to orthopedic clinics.…”

Section: Discussionsupporting

confidence: 86%

“…A substantial number of trials, observational studies, and service evaluations of physiotherapist‐led musculoskeletal triage services in primary and secondary care settings have found that suitably trained CSPs can independently and appropriately manage a significant proportion (50%‐92%) of patients within physiotherapist‐led musculoskeletal triage clinics . A systematic review of extended‐scope physiotherapy practice in patients with musculoskeletal disorders suggests that the quality of care is at least equivalent to that of physician‐led care with respect to diagnostic accuracy, clinical effectiveness, use of health care resources, and patient satisfaction .…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Caffrey

Smart

FitzGerald

2019

ACR Open Rheumatology

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ObjectivePhysiotherapist‐led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist‐led triage in hospital‐based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist‐led rheumatology‐based Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).MethodsA retrospective service evaluation was undertaken of all patients who attended the Rheumatology MAC at St Vincent's University Hospital, Dublin (SVUH) between August 2012 and February 2014. The Clinical Audit Department of SVUH approved the study. Data were analyzed using descriptive statistics.ResultsFive hundred and eight patients attended the MAC: 76% were female and the mean age was 55 years and ranged between 18‐91. Seventy‐five percent of patients were independently managed by the CSP without needing to see a consultant rheumatologist, whereas 17% were referred to the rheumatology team. Eighty‐seven percent of patients referred to the rheumatology team had rheumatological intervention (eg, injection, medical management, or multidisciplinary rehabilitation). A substantially higher proportion of patients with regional musculoskeletal pain and degenerative conditions were independently managed by the CSP compared with those who had rheumatological/inflammatory conditions.ConclusionThe majority of patients who attended the MAC were independently managed by the physiotherapists, suggesting that physiotherapist‐led triage may be a useful and efficient means of managing a proportion of patients referred for a specialist rheumatological consultation.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Caffrey

Smart

FitzGerald

2019

ACR Open Rheumatology

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“…Furthermore, the surgeons also required fewer appointments with patients post-implementation of the Podiatry Triage Clinic (1.9 versus 1.3), further reducing costs. The discharge rate and the surgical conversion rate in this study are similar to other orthopaedic triage roles [ 1 , 4 , 6 ] suggesting that more than half of the non-urgent referrals made to orthopaedic departments can be managed by allied health professionals. The embedded nature of the triage clinic into an orthopaedic department ensures that suitable clinical governance was provided and collaborative care is readily available.…”

Section: Discussionsupporting

confidence: 80%

The integration of a Podiatrist into an orthopaedic department: a cost‐consequences analysis

Walsh

Ferris

Cullen

et al. 2017

Journal of Foot and Ankle Research

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BackgroundThe aim of this study was to evaluate the cost-consequences of a podiatry-led triage clinic provided in an orthopaedic department relative to usual care for non-urgent foot and ankle complaints in an Australian tertiary care hospital.MethodsAll new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014 and 2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015 and 2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on new and review patient appointments; the number of new patients / session; the number of appointments / patient; the number of patients discharged; the surgical conversion rate; staff time; and imaging use were collected. A cost-consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12-month period.ResultsThe Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The Podiatrist consulted with more new patients / session, mean (SD) of 3.6 (1.0) versus 0.7 (0.8), p < 0.001 and utilised less appointments / patient than the Orthopaedic Surgeons, mean (SD) of 1.3 (0.6) versus 1.9 (1.1), p < 0.001. The percentage of patients discharged without surgery was similar in the Podiatry Triage Clinic and usual care, 80.3% and 87.5% p = 0.135, respectively, but the surgical conversion rate was higher in the Podiatry Triage Clinic, 76.1% versus 12.5% p < 0.001. The total integrated appointment cost for the 12-month usual care period was $32,744, which represented a cost of $454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing $94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441.ConclusionsThe integration of a Podiatrist into an orthopaedic department significantly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.

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“…12 These models of care have contributed to shorter waiting times for patients, funnelling of more appropriate referrals to medical specialists 10,13,14 and more timely and appropriate interventions for patients who are not appropriate for or are unlikely to benefit from surgical intervention. 13,15 They have been found to be as beneficial as, or more beneficial than, traditional service models in terms of access to treatment, diagnostic accuracy and patient satisfaction. 16 Research has shown that these models also contribute to more timely provision of care for appropriate patients.…”

Section: Introductionmentioning

confidence: 99%

Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

Chang¹,

Gavaghan²,

O’Leary³

et al. 2018

Aust. Health Review

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Objective. The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals.Methods. A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated.Results. Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged.Conclusions. Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services.What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present for further specialist medical care. What does this paper add? This paper identifies that the majority (95%) of patients managed by an advanced practice physiotherapy-led service did not re-present for further medical care for the same condition within 12 months of discharge. What are the implications for practitioners? This paper supports the use of advanced practice physiotherapy-led services in the management of overburdened neurosurgical and orthopaedic specialist out-patient waiting lists.

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A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

Cited by 28 publications

References 14 publications

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

The integration of a Podiatrist into an orthopaedic department: a cost‐consequences analysis

Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

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