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Bennett A1, Antonopoulos K1, Sullivan N1, Mills H1, Parkinson M1, Heath A1, Amanda S1
1The Royal Marsden Community Services, Musculoskeletal, London, United Kingdom
Background: As a provider of a national health community based musculoskeletal service in the United Kingdom, we provided a Physiotherapy and a Musculoskeletal Clinical Assessment and Triage Service (MCATS). Both services shared the same resources, but ran as separate entities. Our Physiotherapy service provided rehabilitation for patients with musculoskeletal injury. MCATS was predominately a diagnostic service delivered by Advanced Physiotherapy Practitioners (APP's), competent in requesting laboratory, radiological or neurophysiological investigations; undertaking steroid injections and referring patients to secondary care. Both services had separate paper based referral pathways signposted by General Practitioners, vetted by a Physiotherapist. The reliability of this referral process was questionable. The majority of patients assessed in MCATS were referred to Physiotherapy without further investigation. Moreover, Physiotherapists could not refer directly to MCATS.
Purpose: To revise this delivery model to address increasing waiting times, whilst keeping referral rates for investigation and to secondary care to a minimum, and achieving high levels of patient satisfaction.
Methods: We piloted an integrated service, assessing all patients referred within a single triage clinic. Over 5 weeks, 2 clinics were delivered per week between 8am and 6pm; staffed by 2 Physiotherapy Assistants (PTA's),13 Physiotherapists, 2 APP's, a Consultant Physiotherapist and 4 administrators. Patients were invited to attend one of four 2 hourly time windows. On arrival they completed a screening questionnaire. Informed by details derived from this, the patient was signposted for face to face assessment with either a Physiotherapist or APP depending upon the complexity of their condition. Investigations were requested by APP´s and appropriate patients referred to secondary care. Where appropriate treatment was commenced, and they were offered either a follow up appointment or discharged with a self-management strategy. A floating Consultant Physiotherapist exclusive to clinical capacity assisted with clinical reasoning. PTA's facilitated completion of questionnaires and assisted with treatment.
Results: 1838 patients were invited, 1738 opted to have an appointment, 1270 attended, the DNA rate was 25%. Waiting time reduced from 14 weeks maximum for both services to 5 weeks for the new triage clinic. 53% were originally referred to Physiotherapy and 47% to MCATS. 84% were assessed by a Physiotherapist and 13% by an APP. This resulted in a more effective use of clinical time and more efficient patient pathway. 10% required investigations (49% MRI, 20% X-ray, 12% laboratory investigations, 10% Ultrasound, 7% nerve-conduction-study), and 4% were directly referred to secondary care (47% orthopaedics, 28% pain management, 16% rheumatology, 2 % accident and emergency). 93% commenced treatment (93% advice/exercise, 4% ergogenic-aid, 3% injection). 19% were discharged to self-manage. 12% completed the friends and family test, with 99% likely or extremely likely to recommend the service. All clinicians valued the ability to work collaboratively.
Conclusion(s): Using this integrated model we reduced waiting time, achieved low referral rates for investigations and to secondary care, and achieved high patient satisfaction.
Implications: The data derived from this pilot was used to inform a successful business case to attain additional funding to introduce a physiotherapy lead/delivered single point of access triage service replacing the traditional model.
Keywords: Musculoskeletal, Community, triage
Funding acknowledgements: Nil
Purpose: To revise this delivery model to address increasing waiting times, whilst keeping referral rates for investigation and to secondary care to a minimum, and achieving high levels of patient satisfaction.
Methods: We piloted an integrated service, assessing all patients referred within a single triage clinic. Over 5 weeks, 2 clinics were delivered per week between 8am and 6pm; staffed by 2 Physiotherapy Assistants (PTA's),13 Physiotherapists, 2 APP's, a Consultant Physiotherapist and 4 administrators. Patients were invited to attend one of four 2 hourly time windows. On arrival they completed a screening questionnaire. Informed by details derived from this, the patient was signposted for face to face assessment with either a Physiotherapist or APP depending upon the complexity of their condition. Investigations were requested by APP´s and appropriate patients referred to secondary care. Where appropriate treatment was commenced, and they were offered either a follow up appointment or discharged with a self-management strategy. A floating Consultant Physiotherapist exclusive to clinical capacity assisted with clinical reasoning. PTA's facilitated completion of questionnaires and assisted with treatment.
Results: 1838 patients were invited, 1738 opted to have an appointment, 1270 attended, the DNA rate was 25%. Waiting time reduced from 14 weeks maximum for both services to 5 weeks for the new triage clinic. 53% were originally referred to Physiotherapy and 47% to MCATS. 84% were assessed by a Physiotherapist and 13% by an APP. This resulted in a more effective use of clinical time and more efficient patient pathway. 10% required investigations (49% MRI, 20% X-ray, 12% laboratory investigations, 10% Ultrasound, 7% nerve-conduction-study), and 4% were directly referred to secondary care (47% orthopaedics, 28% pain management, 16% rheumatology, 2 % accident and emergency). 93% commenced treatment (93% advice/exercise, 4% ergogenic-aid, 3% injection). 19% were discharged to self-manage. 12% completed the friends and family test, with 99% likely or extremely likely to recommend the service. All clinicians valued the ability to work collaboratively.
Conclusion(s): Using this integrated model we reduced waiting time, achieved low referral rates for investigations and to secondary care, and achieved high patient satisfaction.
Implications: The data derived from this pilot was used to inform a successful business case to attain additional funding to introduce a physiotherapy lead/delivered single point of access triage service replacing the traditional model.
Keywords: Musculoskeletal, Community, triage
Funding acknowledgements: Nil
Topic: Service delivery/emerging roles; Musculoskeletal; Primary health care
Ethics approval required: No
Institution: The Royal Marsden Foundations Trust
Ethics committee: The Royal Marsden Foundations Trust
Reason not required: This represents a service design and not a research project
All authors, affiliations and abstracts have been published as submitted.
