Trial of diagnostic ultrasound in the orthopaedic setting

Purpose

Historically, provision of MSK Ultrasound diagnostics has been via a referral to Radiology. However, there is increasing evidence that assessment, investigation and initiating treatment at the initial appointment is shown to be cost-effective, increasing patient satisfaction. Utilising this approach also reduces repeated hospital visits for further diagnostics and appointment times for results. The aim of using Point of Care (POC) ultrasound is to enhance the patient experience through instant access to diagnosis, timely implementation of most appropriate clinical pathway and achievement of the optimal outcome in the shortest possible time.

This study aims to investigate the benefits of point of care (POC) and schedule ultrasound clinics using a proof of concepts approach in the orthopaedic setting.

Approach

The trial ran for a six week period sourcing all patients referred to the orthopaedic triage service. The trial collected three measurable outcomes. Two Patient Reported Outcome Measures: MSK-HQ and The Care Measure, and a Proof of Concept clinician survey via Survey Monkey. These were completed by the clinicians and patient cohort during the scheduled clinic and POC clinical contact.

Outcomes

A total of 135 patients received a diagnostic ultrasound scan over the six week trial period. 34 patients received a diagnostic ultrasound scan from the Extended Scope Practitioner (ESP) Physiotherapist in a Scheduled Care setting. 101 patients received a diagnostic ultrasound scan from the ESP Podiatrist in orthopaedic triage over the six week period (74 in Scheduled care clinics and 27 at Point of Care).

The outcome measure suggest that patients received a rapid diagnosis (n.135), implementation of appropriate treatment pathway (86.36%), a positive impact on Referral to Treatment (88.55%), appropriate implementation of conservative treatment (91.11%) and had excellent co-production during the trial with an 88% average CARE Measure Score. The MSK-HQ results suggested a wide variety of musculoskeletal conditions were assessed during the trial with a mean MSK-HQ score of 27.6 with a Standard Deviation of 12.

Cost and savings

The project was run using existing Ultrasound equipment available within the Health board.

No additional staff costs were needed as US service was provided as part of package of care for patients attending clinics.

If this service was implemented the projected saving would be seen in the component service of radiology with reduced referral rates to consultant  led US clinics.

 

Implications

Results from clinician sourced Survey Monkey data, the CARE Measure and MSK HQ suggest that POC ultrasound and Scheduled care clinics offer a positive benefit for the patient's care pathway, are beneficial clinically and suggest adequate demand for the service.

It is recognised that appropriate use of ultrasound has the potential to improve quality of care but robust clinical governance is required to ensure that procurement and deployment of equipment is appropriate, service provision is evidence based and delivered by qualified and competent clinicians. Patients are the primary benefactors of POC ultrasound with improved diagnostic accuracy, faster and appropriate implementation of treatment pathways and demonstrating excellent co-production with the patient population. Radiology is also a co- benefactor with the likely reduced referral rates to the service.

Top three learning points

  • Moving diagnostic services closed to point of contact improves patient care and reduces delays  in implementation of  treatment
  • AHP with appropriate training can deliver US examinations as part  of standard care
  • Development  of  point  of care clinics with  integrated imaging facilities should be seen as natural development  of AHP lead clinics

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.