Expert Panel - Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services: Supplementary Annexure
4.9 Tasmania - North West Area Health Service Orthopaedic Early Intervention Service
DescriptionThe Orthopaedic Early Intervention Service (EIS) commenced at the end of January 2011 and is a multidisciplinary team consisting of a Team Leader, Extended Scope Physiotherapist, Clinical Pharmacist, Occupational Therapist, Dietitian, Prehab Physiotherapist and Administrative Assistant. The EIS Team functions in conjunction with the Orthopaedics clinic and Elective Services and is the first contact for assessment, case management and prioritisation of patients referred to the North West Area Health Service (NWAHS) Orthopaedics Department by General Practitioners with hip or knee pain.
The focus of the service is around timely access to multidisciplinary clinics for patients with hip and knee joint problems across the North West Region with outreach clinics to Smithton and the West Coast.
The service consists of an initial telephone triage followed, if appropriate, by a team comprehensive assessment using standardised repeatable outcome measures such as the six minute walk test, the Canadian Occupational Performance Measure (COPM), and the Multi Attribute Prioritisation Tool (MAPT).
The EIS Team provides the following:
- Identification of patients requiring surgical consultation and those who can be managed conservatively.
- Case management in consultation with patients experiencing complex needs including cross referrals to Allied Health therapeutic programs, regular review, repeat MAPT scoring and GP liaison.
- Fast-tracking of patients with urgent problems (Triage Category 2) or deteriorating conditions to the Orthopaedic Consultants for review.
- Optimisation of physical condition and preparation for patients scheduled for elective hip and knee joint arthroplasty through the ‘Prehab Program’ and weight loss and community programs.
- Implementation of the MAPT (Multi Attribute Prioritisation Tool) to validate the standardisation of the Orthopaedic waiting list prioritisation process.
RationaleThe NWAHS established the EIS Team with the aim of ensuring timely intervention for patients awaiting Orthopaedic consultation, standardising prioritisation procedures for the Orthopaedic Elective Surgery waiting list and optimising patient physical condition prior to elective surgery.
The NWAHS EIS program is based on the very successful reform of Orthopaedic outpatient process completed at Barwon Health, Victoria. The outcomes at Barwon resulted in significant reduction in waiting times for initial Orthopaedic consultation. Within one year of the extended scope Physiotherapy Clinics, the waiting list had reduced from 1100 patients waiting up to 23 months for non-urgent review in January 2004, to 370 patients waiting less than three months for their first appointment.
The EIS was also based on work completed on the Orthopaedic Waiting List Project (OWL), Victoria, and outpatient redevelopment work in Western Australia and Queensland.
OutcomesSince commencement in late January 2011 this year, the EIS Team has assessed 230 patients. Approximately 10 per cent have no longer required assessment or Orthopaedic intervention by the Orthopaedic Consultants at this point in time. Removal of patients for a variety of reasons, such as other life threatening health condition, no longer wishing surgery, already had surgery privately or input from Allied Health Professional has improved their problem.
With a focus on partnering with patients in the management of their condition, there has been consistently high compliance with scheduled appointments and participation in therapeutic programs and compliance with program and clinical outcomes such as improvement in MAPT Scoring, and fitness measures. An interim patient satisfaction survey completed in June 2011 showed high patient satisfaction with the service provided by the EIS team.
Future directions for the EIS Team include:
- Expansion of the project to include assessment of all conditions referred to the Orthopaedics Department.
- Continued education of General Practitioners around the utilisation of Allied Health Services for Musculoskeletal conditions.
- Research opportunities.
- Inclusion of other outcome measures such as the K-10 to monitor psychological and overall well being.
- Inclusion of Extended Scope Physiotherapist at Fracture Clinics performing Total Knee Replacement/Total Hip Replacement reviews to complement the Orthopaedic Registrar reviews.