Multidisciplinary Co-Cared Triage Model to Enhance Early Interventions for Non-operative Spinal Outpatients

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Authors (including presenting author) :
Wong WL(1), Law SW(2), Cheuk C(3), Choi YKS(3), Chun YWE(1), Kam SW(1)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital, (2)Department of Orthopaedics & Traumatology, Prince of Wales Hospital, (3)Department of Family Medicine, Prince of Wales Hospital
Introduction :
Service demand for specialist intervention in outpatients with spinal pain is overwhelming and is still in increasing trend. Patients are often required to wait for years to attend a specialist consultation in public sector. In Prince of Wales Hospital (PWH), a multidisciplinary co-care by Orthopaedics & Traumatology (O&T), Family Medicine (FM) and Physiotherapy was started in October 2017 to tackle this problem. This is a new fast-track spinal triage program to provide early medical and physiotherapy interventions for patients with non-operative spinal pain.
Objectives :
 To evaluate the process time required for non-operative spinal cases to receive specialist care and/or physiotherapy treatment  To evaluate the new service model in view of percentage of case required O&T follow-up after FM consultation and clinical outcomes
Methodology :
Spinal cases referred to O&T Department, PWH, unless with serious pathology written on the referral, were triaged in PT Department. After individual assessment was carried out by a physiotherapist, suitable routine case without red flags sign would be selected to enroll in the new co-cared model. Endorsed by the O&T doctor, selected cases would be referred to FM instead of putting into routine O&T waiting list. Cases would then be looked after by Specialist in FM; physiotherapy referral would be given if indicated.
Result & Outcome :
From October 2017 to Nov 2018, 509 cases were selected for co-care. This accounted for 25.5 % of all routine O&T spinal cases in the period. Time to first FM consultation was 4 to 17 weeks; the waiting time for O&T spinal routine cases was about 130 weeks before the commencement of this collaboration. Among all cases, only one case required O&T follow-up after FM consultation. The waiting time for physiotherapy was 2 to 8 weeks. The Numeric Global Rating of Change Scale of patients receiving full course of physiotherapy was 6.4. The Numeric Pain Rating Scale improved from 5.0 to 2.2 (P<0.05). For low back pain cases, the score of the Roland Morris Disability Questionnaire improved from 11 to 7 (P<0.05), and the score of the Northwick Park Neck Pain Questionnaire for neck pain cases improved from 41% to 15% (P<0.05). Conclusion: With seamless multidisciplinary collaboration, non-operative spinal outpatients could have faster access to specialist care and indicated treatments with promising clinical outcomes.

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