The Spine Triage and Rehabilitation (STAR) clinic aims to reduce wait times and lower medical costs for patients with spine issues by using physiotherapists as the first point of care. This approach offers quicker access to treatment, minimises unnecessary specialist referrals, and focuses on non-surgical management. It streamlines patient care while reducing the workload on specialists and improving overall healthcare efficiency.
We conducted three Plan-Do-Study-Act (PDSA) test cycles.
PDSA 1
The STAR Clinic began as a one-month trial with bi-weekly, 60-minute sessions, but these were reduced to 30 minutes for better efficiency. As demand grew, more physiotherapists were introduced, increasing outpatient capacity while maintaining the improved 30-minute session format.
PDSA 2
Initially, patients did not consistently see the same physiotherapist for follow-up appointments, but to improve continuity of care, efforts were made to match patients with the same physiotherapist for subsequent visits. This change received positive feedback from both patients and physiotherapists and has been maintained since.
PDSA 3
Finally, the STAR Clinic promoted its services at the primary care level due to underutilization. After presenting results to the primary care department on reduced wait times, high patient satisfaction, lower costs, and safety, clinical attendance increased by nearly 60%. However, the rise in patient referrals was not sustained without ongoing reminders, especially as junior physicians rotated through postings.
More than 300 patients were recruited to the STAR Clinic Programme and their progress was tracked over 13 months under the four main domains: waiting times, cost saving, safety and patient satisfaction.
Waiting Time
- Percentage of patients waiting >60 day: 34.5% → 0 - 1.3%
- Median wait time: 61 days → 36 - 44 days
Average Cost Saving per Patient
- 415 SGD (69%)
- Medical Officer Clinic - 602 SGD
- STAR Clinic - 187 SGD
Patient Satisfaction Rate
- 100% in all domains of questionnaire (in the 87 patients that responded to the survey)
Concordance Rate
- 99.5% agreement between physiotherapist and spine consultant (for both diagnosis and treatment plan)
Our pilot study of a physiotherapy-led triage clinic demonstrated significant improvements in wait times and cost savings, with high patient satisfaction and minimal discord between physiotherapists and physicians. The system has been sustainable for over a year, and we recommend its adoption by other institutions while stressing the importance of proper training and safety.
With promising outcomes, the intention is to expand the service and share our first-hand experiences with other institutions in considering a similar strategy for improved efficiency.
