TEAMS - towards integration of services
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The document discusses the efforts in North Wales to integrate musculoskeletal services to improve access, reduce waiting times, and enhance patient outcomes. Key changes include the establishment of common access points, GP referral triage systems, and the introduction of community-based clinics, which have led to significant improvements in patient throughput and reduced wait times. Overall, the integration of these services has demonstrated effectiveness in managing musculoskeletal problems and has been positively received by both GPs and patients.
TEAMS - towards integration of services
- 1. TEAMS - towards integration of services Rhian Lewis Ysbyty Gwynedd Bangor
- 2. Chaos
- 3. TEAMS T argeted E arly A ccess to M usculoskeletal S ervices Reorganisation of services Problems encountered Improvements achieved
- 4. Order
- 5. Bangor
- 6. North Wales
- 7. Challenges Difficulty in coping with referral demand Long waiting lists No acute back pain service Patients on multiple waiting lists Limited co-ordination of services Inappropriate referrals in orthopaedics – low surgical conversion rates
- 9. Wider environment WAG programme: Innovations in Care in orthopaedics Project group on accessibility of musculoskeletal services
- 10. TEAMS working party GP representing local health group Senior manager Orthopaedic surgeon Pain management consultant P hysiotherapist R heumatologist
- 11. Aims of TEAMS Improved access to services Reduced waiting times Timely surgery
- 12. Key features Common access point Triage into appropriate specialty Development of care pathways ESP-led Back Pain Service Community-based musculoskeletal clinics Fibromyalgia clinic
- 13. Integration of services GP referral Triage Surgical advice Chronic back OA/soft tissue Arthritis/CTD Acute back Physio assessment Pain management Rheumat- ology Orthopaedic service
- 14. Difficulties to overcome Change is threatening Rheumatologists ?Take-over bid? Ortho objected to pooled referrals Delegation of responsibility Supporting new nurses time-consuming
- 15. Acute back pain New service: ESP (physio) triage Reduce acute backs seen in ortho Screen Red flags (fast-track to ortho) Onward referral of Yellow flags to pain clinic Weekly meeting of ESP with pain clinic MDT
- 16. Acute back pain pathway Orthopaedics GP Referral Teams Co-ordinator RED Flags ESP screening / telephone Re-assessment Pain Team/Epidural Physio Treatment Resolving D/C Further physio
- 17. Telephone reviews TENS and drug reviews by specialist nurses Greater emphasis on education, exercise and self-management Flare-up protocols Weekly MDT meeting Chronic pain - changes
- 18. Pain clinic - staff increases 3.5 Consultant sessions 0.5 Specialist nurse 0.5 Psychologist 0.5 Physiotherapist
- 19. Chronic pain - results Increased throughput – 400 -> 700/year Waiting list of 2-3 months (down from 12 months) Acute referrals from ESP seen within 1 week
- 20. Rheumatology - changes inflammatory triage GP referral non-inflammatory rheumatology musculoskeletal
- 21. New programme - GPwSI 5 GP's with an interest in MSM Work closely with ESP Physio Triaged by rheumatology consultant Overseen by clinical lead Treatment of uncomplicated musculoskeletal problems
- 22. Musculoskeletal clinics One clinic weekly in each geographical area Bangor, Llandudno, Holyhead, Pwllheli, Dolgellau 125 patients a month Monthly combined education programme
- 23. Rheumatology - results Reduced waiting times Greater responsiveness to patients More use of nurse-led, multidisciplinary review clinics Telephone helpline
- 24. Orthopaedics - changes LBP seen by ESP Musculoskeletal to GPwSI and ESP Reduction in out-patient waiting times Surgical conversion increased to 60%
- 25. Educational meetings Physio GPwSI Ortho trainees A and E staff GPs
- 26. Results in first year (2002) Total monthly referrals 400 --> 900 Orthopaedic share 250 --> 200 Increase in pain, MSM, physio Abolished duplicate referrals Surgical conversion rate improved
- 27. Waiting time reductions (weeks) 2001-2002 T and O 52 --> 13 36 --> 9 52 --> 7 Pain Rheumatology
- 28. Current position 2007 Improvements maintained Referrals 890/month Waiting times maintained
- 29. Pain clinic perspective Back pain service in place ESP and Pain clinicians Increase in: semi-acute backs MRI scans tertiary referrals
- 30. What did we learn? Integration improves services Community clinics effective for uncomplicated musculoskeletal problems Nurse-led clinics can reduce W/L Acute back pain service valued by GPs Helpline valued by patients
- 31. TEAMS - the answer? One-stop shop for patients Joined up services for practitioners