Front row from left, Susan Murphy, Clinical Specialist Physiotherapist and Professor May Cleary, Consultant Orthopaedic Lead, University Hospital, Waterford/
Back row from left, Orla Kavanagh, Director of Nursing UHW, and Ben O’Sullivan, Operations Manager, UHW
An outpatient Virtual (video) Specialist Spine Clinic between the National Orthopaedic Spine Centre in the Mater Misericordiae University Hospital, Dublin and the Department of Orthopaedics, University Hospital Waterford won first prize at the 2021 European Association of Hospital Managers (EAHM) Innovation Awards for newly implemented projects.
The Orthopaedic Service at University Hospital Waterford (UHW) serves a population of 500,000 people. Currently UHW has no dedicated orthopaedic spine service. Approximately 10% of spinal patients require specialist surgical spine opinion Currently potential orthopaedic spinal surgical patients at UHW experience lengthy and convoluted routes to access the appropriate care in other dedicated Spinal Orthopaedic centres nationally. There is currently no structured pathway for surgical spine patients at UHW to access the appropriate care.
In collaboration with the National Orthopaedic Spine Centre at the Mater Misericordiae University Hospital (MMUH) Dublin, a novel Virtual (video) orthopaedic spine clinic has been developed for potential spinal orthopaedic patients from UHW who require spinal Orthopaedic surgery. This is a new service which commenced in September 2021.
Patients are screened in advance at in-person Orthopaedic clinics in UHW and if their clinical presentation and investigations are indicative of significant pathology that warrants surgical opinion, they are listed for discussion at the Virtual(video) Spine clinic.
To enable the new virtual pathway to function to greatest efficiency, a Rapid Access Spinal pathway was developed. Traditionally, all spine referrals no matter how acute could remain on UHW orthopaedic waiting lists for up to two to three years.
With the new rapid access pathway, clinically appropriate patients are identified at time of referral and fast-tracked to in-person orthopaedic clinics. These patients are reviewed at in-person orthopaedic clinics within two months of referral. If surgical opinion is indicated following this consultation, the patient is listed for discussion at the next Virtual UHW/MMUH Spine clinic.
The Virtual (video) Spine Clinic is scheduled the first Friday of every month. Six patients are listed for discussion at each virtual clinic. The duration of the clinic is approx. 90 mins.
The platform used for the meeting is Webex. A spinal surgeon and clinical specialist physiotherapist from MMUH link in virtually (video) with the Orthopaedic Team at UHW including Orthopaedic Consultants and Clinical Specialist Physiotherapists. The Pain team at UHW also link to the meeting. Potential surgical candidates are listed for the clinic and the relevant radiology is uploaded on the system and shared between the two centres. Relevant clinical documentation is forwarded to the MMUH team in advance of the meeting. Patients are presented by the UHW team, the images reviewed and discussed by both parties and an opinion given by the MMUH Spine team. The three main outcomes from the Virtual Spine clinic are (1) Surgery, (2) Pain Intervention (3) Continue conservative management i.e.physiotherapy etc.
At the first two clinics, conversion rate to surgery was 60%. Patients who required surgery were managed at the National Orthopaedic Spine Centre MMUH, Dublin and received their surgery within six weeks. If pain intervention was indicated, protected slots had been secured for patients within the Pain Service at UHW and patients received their pain intervention within four weeks (routine wait time was two years). Patients who required ongoing conservative management are referred directly to primary care services.
The development of the Rapid Access Spinal Pathway and Virtual (video) Spine Clinic ensures that a vulnerable client group can access appropriate care in a timely manner. This is a significant quality improvement initiative and is in line with Irish Government ‘Slaintecare’ policy of managing the patient at the right time, in the right place, by the right person.
Patient waiting times have been significantly reduced and patients are now offered appointments based on clinical need rather than on a chronological basis of when they were referred. The virtual clinic is a very cost-effective medium of service delivery as no additional resources with respect to staffing or infra-structure are required in either centre. In addition, this improved service is less onerous for the patient as they do not have to travel for a specialist surgical opinion. In addition, the wait time to obtain this surgical opinion is significantly reduced leading to a faster resolution of symptoms and improved quality of life.
“There are several other orthopaedic centres in Ireland, which, similar to UHW, do not have a dedicated 0rthopaedic spine service. The virtual model of care which has been developed between UHW and the National Orthopaedic Centre/MMUH can easily be replicated across other 0rthopaedic centres in Ireland with minimal cost implications. Therefore, the transferability of this service to other locations across Ireland is high and also adapting this model of care for other clinical specialties is also a viable option,” said Susan Murphy, PhD, a Clinical Specialist Physiotherapist, Orthopaedic Department, University Hospital Waterford, Ireland.
“This virtual Orthopaedic Spine service is in its infancy. Constant evaluation of this service is fundamental to its sustainability. Patient satisfaction questionnaires have been developed to gain feedback from patients on their experience. Local GPs will also be polled to gain their feedback on the service and how their needs are being met.
“A Virtual (video) orthopaedic spine clinic between a National Orthopaedic Spine Centre and a regional non-spinal surgical orthopaedic centre seems to provide an efficient, cost effective and viable option of service delivery for patients with significant spinal orthopaedic dysfunction. Ongoing evaluation of this service is required to ensure it’s sustainability.”
The development team for this project include Mr. Marcus Timlin, Consultant Orthopaedic Spine Surgeon, National Spine Centre, MMUH, Dublin, Professor May Cleary, Consultant, Orthopaedic Surgeon, UHW, Susan Murphy PhD, Clinical Specialist Physiotherapist, UHW, Grace Rothwell, Hospital Manager, UHW, Siobhan Corcoran, Business Manager, Orthopaedic Department, UHW.
