Back off Specialists

A New Spine Pathway  2016-2017

Advanced practice physiotherapy skills used prior to First Assessment Specialist referrals to orthopaedics

Vision: accessibility, partnerships, excellent clinical outcomes, timely access.

Previous model: Overloaded Orthopaedic services, fiscal restraints, unnecessary  admissions/ tests, onsite underutilised expertise.

Changes:

Triage referrals. Orthopaedic specialists direct patients to Physiotherapist-led back clinic after paper triage only

Data tracked. Educational tools Developed home program templates, back booklet, exercise sheets

Integration and communication of pathways with other services

Outcomes Keele STarT Back, VAS

Target population: High needs communities, throughout Hawkes Bay

Results:

 Reduced speicialist appointment/investigations:

87% avoided,

119   fewer MRIs         

88   fewer spinal injections                        

Accessible service: 

average   interventions  3.4

Average wait time 41.6 days.

542 people offered assessment in   first year

Avoidable hospital admissions:

 trending   down ( HRT data 2016)

 Client satisfaction high:

79%   rate 10/10

Outcomes:

at  discharge 81% self managing well, minimal or no symptoms,

7% referred on to community support   groups,

12% referred to FSA/specialist   service

Patient reported average Outcomes:

Pain scores  improved 23.9%,

function   17.2%,

self management improved 33.8%

Sustainability: Further 0.5 equivalent advanced pracitioner employed mid 2016. data  consistent over 18 months

Enhancement of client services: more clinics opening in outlying community settings.

Message for others: Expert Physiotherapists work with hospital specialists, staff, referrers, and community to ensure clients receive accessible appropriate expert care and back up.  This service saves money, reduces diagnostic interventions, Orthopaedic Specialist time, while producing excellent outcomes.

Treatment emphasising self-care, lifestyle change, supported by excellent educational tools, works for all stakeholders.