Authors (including presenting author) :
Cheung YM(1), Cheung PCL(2), Leung AL(1), Lee SY(2), Wong J(2), Li W(2)
Affiliation :
(1) Ambulatory Care Centre, Queen Elizabeth Hospital (2) Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Musculoskeletal conditions are very common in Hong Kong, affecting all ages, and has created a rather large patient load for Orthopaedics and Traumatology Outpatient Clinics. The burden is predicted to increase dramatically unless action is taken. Patients with musculoskeletal pain often worry about delaying seeing a doctor specialized in this condition. Some require specialty level of care and some do not. Risk management is required to manage the population concerns on time.
Objectives :
(1) To shorten waiting time for specialist clinic (2) To speed up waiting time for necessary surgery (3) To empower patient in musculoskeletal management
Methodology :
The control group (August 2018 to September 2010, n=2194, tail-end waiting time=105 weeks) is patients attending Joint Clinic. The intervention group (April 2019 to December 2019, n=486) is patients attending Musculoskeletal (GMSK) Clinic. Outcome measures were: (1) Waiting time for first appointment, (2) Number of patients taken over by Joint Clinic, referred to General Out-patient Clinic, and discharged with case closed. (3) Number of patients with joint surgery booked.
Result & Outcome :
As expected, the waiting time for first appointment in intervention group was shortened from 90 to 52 weeks. Complex cases requiring specialty level of care were taken over by Joint Clinic ( n=54). Selected routine patients were diverted to General Out-Patient Clinic for appropriate level of care (n=2). Non-indicated patients were discharged with case closed (n=41). Patients with joint deterioration with consent were scheduled for elective surgery (n=4). Majority of patients were recruited for Self-empowerment Programme (n=385). With life modification, patients demonstrated significant improvement in Get Up and Go test (P<0.05), pain control (P<0.05) and Mental Component Scores in SF-12 Quality of Life (P<0.05). With existing manpower, we have enhanced services for patients with musculoskeletal pain in need. With GMSK clinic, the overall waiting time in Joint Clinic was shortened from 105 to 88 weeks. With musculoskeletal clinic, high risk or with early features of musculoskeletal conditions were timely identified. Awareness of what can be achieved for musculoskeletal conditions by lifestyle interventions, surgery and rehabilitation was effectively enhanced. Caseload has been efficiently managed via integrated multidisciplinary model focused around the needs of individuals.
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