C. Treanor1, W. Lenehan1, C. Gallagher1, J. Caird1, B. Hussein1, M. Javadpour1, S. McNally1, D. O'Brien1, D. O'Brien1, C. Bolger1,2, A. Malone3
1Beaumont Hospital, Neurosurgery, Dublin, Ireland, 2Royal College of Surgeons in Ireland, Clinical Neurosciences, Dublin, Ireland, 3Royal College of Surgeons in Ireland, School of Physiotherapy, Dublin, Ireland
Background: In Ireland people with symptomatic degenerative spinal conditions who are referred for neurosurgical assessment often face long wait times, particularly if their presentation is deemed non-urgent. Long waits are associated with diagnostic and treatment delay, which negatively impacts patient experience and outcome. Clinical specialist (CS) physiotherapists, working as first contact practitioners in other musculoskeletal consultant clinics in Ireland, have positively impacted waiting lists and wait times. This is the first evaluation of such initiatives in the neurosurgical setting.
Purpose: The aim of this service evaluation was to measure the impact of increased CS physiotherapist capacity to assess patients with spinal problems, on waiting lists and wait times for assessment in a national neurosurgical clinic, particularly focusing on long (>1 year) wait times.
Methods: Data for this evaluation were retrospectively extracted from the Hospital Information System (Diver Platform, Dimensional Insight). The number of new referrals, number of patients waiting, length of wait for assessment, and number of new patients assessed in clinic, were recorded in monthly snapshots, taken on the last Thursday of each month, over a three year period from 1 January 2017 to 31 December 2019. The neurosurgical service employed 0.6 whole time equivalent (WTE) CS physiotherapists for the 18 month period January 2017 to June 2018 (T1), and 2.6 WTE for the subsequent 18 months July 2018 to December 2019 (T2). Data were compared for these two intervals, using descriptive non-parametric statistics (medians, ranges, percentages).
Results: The median number of patients on the waiting list each month during T1 was 2,349 (range 2181-2518), compared to 1,874 (range 1523-2271) during T2. The total waiting list reduced by 661 patients from the end of T1 to the end of T2, representing a 30.3% reduction in the waiting list, of whom 638 (95.7%) had been waiting >1 year. By the end of T2, 74 patients had been waiting >1 year compared to 712 at the end of T1, representing an 89.6% reduction in long wait times. During T1, 0.6 WTE CS physiotherapists assessed 266 of 2590 new patients in the neurosurgical clinic (10.3%), compared to 966/3874 (25%) assessed by 2.6 WTE during T2. This change coincided with a 32.5% increase in referrals to the clinic from 5590 during T1 to 7410 during T2.
Conclusion(s): The increase in CS physiotherapist capacity in the neurosurgical outpatient clinic led to an overall 30.3% reduction in the number of patients on the waiting list and an 89.6% improvement in the number of patients with long wait times >1 year. These improvements occurred despite a 32.5% increase in referrals to the service. CS physiotherapists assessed 25% of all new patients referred, demonstrating a significant contribution to the overall capacity of the clinic.
Implications: CS physiotherapist capacity was associated with a positive and sustained improvement in waiting times for outpatient review in the Irish national neurosurgical centre. These findings have implications for similar services in other countries, and are relevant for the expanding role of physiotherapists as first contact practitioners.
Funding, acknowledgements: No funding
Keywords: spine, service evaluation, clinical specialist physiotherapy
Topic: Musculoskeletal: spine
Did this work require ethics approval? No
Institution: Beaumont Hospital, Dublin, Ireland
Committee: Beaumont Hospital Ethics (Medical Research) Committee
Reason: This work is a service evaluation and is not classified as research
All authors, affiliations and abstracts have been published as submitted.
