The management of patients presenting to a large metropolitan hospital with back or neck pain using an evidence-based approach whilst improving efficiency of service delivery is a challenge. The development of a pathway to manage these patients was undertaken as a proof of concept trial.
Solution: Collaboration between the executive of the hospital, the North Sydney Local Health District and the Agency for Clinical Innovation enabled the development of a management pathway for all patients presenting to, or referred to the hospital with spinal pain.
A triage physiotherapist facilitated a decrease the long waiting time for appropriate patients to access a surgical opinion in the ambulatory care department, on referral by their general practitioner. The physiotherapy service ensured evidence-based care was delivered to patients after a comprehensive assessment and referral if necessary.
Results: The triage physiotherapy process facilitated a substantial decrease in average waiting time for patients to access a spinal surgical clinic from 381 days in January 2016 to 65 days in March 2017. 644 patients were triaged. 296 patients (46%) were offered a comprehensive physiotherapy assessment. Of the 211 patients that attended the physiotherapy assessment, 164 (78%) were managed conservatively without a surgical opinion, 47 (22%) were offered a surgical opinion and of those only seven patients were offered surgery.
Conclusion: A triage physiotherapist utilising a clear pathway to manage patients with back and neck pain has demonstrated improvement in patient access to appropriate services. The extension of this model of service could be considered by other local health services.