THE new Pain Management Centre at Croom Orthopaedic Hospital is providing an enhanced quality of service to patients, with dramatically reduced waiting times, according to the authorities.
Investments in the infrastructure at Croom Orthopaedic Hospital, and in the staffing of the service led by Professor Dominic Harmon, have led over the past 18 months to a reduction in wait times from referral to review from 49 months to 60 weeks, while the intervention lists have decreased in line, from 60 weeks to 12 weeks.
Since 2021, the service staff has increased from one consultant, two Clinical Nurse Specialists and two clerical workers, to an additional 11 staff nurses, one Clinical Nurse Manager (CNM2), one Clinical Nurse Specialists, one candidate Advanced Nurse Practitioner (cANP), one Psychologist and four Multi-Task Attendants (MTAs). Further appointments are on stream, including one further CNS, one Radiographer two Physiotherapists and one Music Therapist.
The new base of operations has facilitated the amalgamation of services underway over the past 18 months, which uses the ‘hub and spoke’ model of healthcare, with a centre of excellence based in the acute setting, and links to the community and GPs in order to provide improved care.
There has been an immediate increase in the number of interventions, which, over the past 18 months has grown from 18 per week to up to 50 patients every week.
Anna Marie Kiernan, candidate Advanced Nurse Practitioner in Pain Management, who has worked alongside Prof Harmon throughout this process, is quick to stress that the improvements should not only be regarded in terms of numbers of patients seen, but in quality of service delivery.
“What has been achieved stems from our vision of the healthcare model, and a fresh focus on the processes that we had in place. At the time, our waiting lists from referral to review of 49 months, and approximately 60 weeks then for intervention, was an extremely long time for someone who is pain to wait for treatment,” Ms Kiernan said.
“What we identified was that it was key to put more work into the referral triage process in order to maximise the quality of referrals from GPs. This then leads to improvements in the quality of provisional diagnosis by our service. We worked closely with GPs in the region to better inform our multidisciplinary triage process. This closer relationship with GPs has enabled us to provide more rapid and accurate provisional diagnosis,” she explained.
“By supporting GPs, we are also helping to educate and inform on the proper analgesic decisions for patients in the community.”
The complexity of the process stems from the peculiarities of diagnosing pain, which firstly is subjective, but also has underlying contributors. “Pain is a symptom,” Ms Kiernan said. “By treating the symptom, you are putting a plaster on the symptom. Our focus is on identifying what the cause is, so that we can give an accurate diagnosis, address the underlying problem, and provide long term symptom management which will reduce the patient’s suffering. Diagnosis is key, and by doing the triage earlier, we can also refer to other specialist services based on the diagnosis. When you come to us, you’re not just waiting to see us in a clinic.
“Previously, we had to rely on GPs more to refer to other services based on our recommendations, but now they have more immediate access. We can provide, as part of our service, access to services that they previously might have had to pay for themselves, such as a psychology and physiotherapy.”
The future for the Pain Management Service involves ongoing amalgamation of services with the ultimate goal of empowerment of patients in the community, and reduction of the impact on specialist services, and on the Emergency Department where people often present with chronic pain issues.
