Spinal Triage by Extended Scope Physiotherapists in a diagnostic interface clinic: Spinal unit conversion rates from a 12-month service evaluation.

Purpose

The Back and Neck Service (BaNS) was established in Suffolk (2003) as an interface clinic with the aim of reducing unnecessary referrals into the secondary care Spinal unit for surgical opinion. Since this time the service has expanded and now consists of six Extended Scope Physiotherapists (ESP) across the East (BaNS-East) and West (BaNS-West) localities. Importantly, the BaNS is embedded within a wider spinal pathway spanning both primary and secondary care which allows timely self-referral to musculoskeletal physiotherapy via a Single Point of Access (SPOA) portal. Patients with radiating symptoms failing to improve at 6-weeks, or those with axial symptoms that have failed appropriate management can be referred into the BaNS by their treating physiotherapist or via their General Practitioner. Following assessment and, where indicated, investigation(s), suitable cases are reviewed with a spinal consultant at a weekly meeting where appropriate patients can be directly referred into the secondary care spinal unit. The purpose of this service evaluation was to establish the effectiveness of the BaNS in triaging patients with axial and/or radiating symptoms into secondary care and to report the conversion rate to surgically led interventions (nerve root block injections & surgery). A secondary aim was to establish patient satisfaction with the service.

548 (22%) patients from the BaNS-West and 527 (16%) patients from the BaNS-East
were referred into the secondary care spinal unit.
308 (70%) of patients referred by the BaNS-West and 362 (80%) of patients referred by the BaNS-East
underwent surgically led intervention (nerve root block and/ or surgery), excluding patients that had improved or failed to attend their Spinal Clinic appointment
A total of 5,759 patients were assessed
during the data collection period.
A 100% satisfaction rate was reported
by a small convenience sample of patients (n=148).

Approach

A retrospective service evaluation incorporating data from January 2018 to January 2019 was undertaken by the BaNS ESP. Data regarding number of referrals into the service was retrieved electronically from the SPOA system. Referral rates into secondary care were established from hand review of MDT meeting referrals. Conversion rates for interventions were established by manual review of each patient’s electronic hospital record. All data extraction was checked by a second reviewer. Patient satisfaction was evaluated from questionnaires issued to a convenience sample of patients during the collection period.

Outcomes

A total of 5,759 patients were assessed during the data collection period. 548 (22%) patients from the BaNS-West and 527 (16%) patients from the BaNS-East were referred into the secondary care spinal unit. Excluding patients that had improved or failed to attend their Spinal Clinic appointment, 308 (70%) of patients referred by the BaNS-West and 362 (80%) of patients referred by the BaNS-East underwent surgically led intervention (nerve root block and/ or surgery). A 100% satisfaction rate was reported by a small convenience sample of patients (n=148).

* Data for patient outcomes not referred into the secondary care spinal unit is pending and will be available for presentation at conference.

An ESP led interface service within a wider designated spinal pathway is effective at triaging appropriate patients for surgically led spinal intervention who have failed primary care management. Further evaluation is required to report on ESP diagnostic accuracy, patient outcome and cost effectiveness of the service in addition to establishing satisfaction rates from a larger patient sample. This work is ongoing.

Cost and savings

Costings not analysed as part of this evaluation.

Implications

This evaluation supports previously published data demonstrating the effectiveness of utilising ESP in performing spinal triage. With the introduction of the National Back Pain Pathway, this evaluation provides data from an established interface service that might be helpful for those wishing to develop and justify a similar pathway.

Top three learning points

  1. Retrospective (manual) data collection is extremely time consuming. Far better to put in place prospective data capture systems to allow easy recall of pertinent information at any time point in the future.
  2. The value and importance of having comprehensive data from a prolonged period (12 months) when discussing and justifying service expansion to commissioners.
  3. The benefit of sharing methods/ results regionally (via an organised pathway day) which led to several other services completing similar data collection/ evaluations (often for the first time).

 

Fund acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019

Please see the attached Innovations poster below. 

 

For further information about this work please contact Luke Hills