National Health Reform

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

Description

The 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.

Rationale

The 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.