Background Patients with musculoskeletal (MSK) disorders may remain on lengthy hospital outpatient waiting lists to be reviewed by a consultant doctor, although medical or surgical intervention may not be required (1,2). In 2012, a waiting list initiative saw the introduction of Advanced Practice Physiotherapists (APPs) across 16 hospitals in Ireland. APPs triage and manage patients awaiting a consultant doctor appointment, who are deemed non-urgent or unlikely to require surgery on screening of referral letters. APP scope of practice generally involves some traditionally medical-controlled acts such as: administering injections, ordering investigations/imaging, surgical listing and onward referral to hospital specialities; and depending on consultant doctor availability, their input may be sought on clinical decisions if required.
Profile the national APP patient caseload
Establish the clinical outcomes of APP consultations
Methods A national database was established with all APPs (n=22) submitting patient data for 2014. These data were analysed using descriptive statistics.
Results Data showed that APPs assessed 13,981 new patients, who presented most commonly with MSK disorders of the knee (n=3,096), lumbar spine (n=2,926) and shoulder (n=1,945) (Fig. 1) and the median wait time was 167 days (IQR 91–316). Including an additional 2,596 return appointments, the most common clinical outcomes were physiotherapy and/or clinical investigations (Table 1), and clinical decisions were made independently by the APP in 77% (n=11,728) of recorded cases (n=15,189).
Conclusions APP services provide a more efficient MSK clinical pathway and reduce demands on the Consultant Doctor services. Collection of National Data enables ongoing service evaluation and monitoring of key performance indicators.
Wood, L., Hendrick, P., Boszczyk, B. & Dunstan, E. 2016. A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting. Ann R Coll Surg Engl, 1–5.
Desmeules, F., Toliopoulos, P., Roy, J. S., Woodhouse, L.J., Lacelle, M., Leroux, M., Girard, S., Feldman, D.E. & Fernandes, J. C. 2013. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic. BMC Musculoskelet Disorders, 14, 162.
Acknowledgements I would like to thank the National Clinical Programmes and Health Service Executive for their funding and support of this project.
Disclosure of Interest None declared