Set-up of a one stop multidisciplinary shoulder clinic - A quality improvement project
By Kate Ashfield, Altnagelvin Hospital, Londonderry, Western Health and Social Care Trust
Objective
Routinely, patients attend an orthopaedic shoulder clinic, and following the consultant’s clinical decision, may be referred for investigation or physiotherapy. Review following the decided intervention can take many months due to lengthy waiting lists. Introducing a multidisciplinary one stop shoulder clinic, the first in Northern Ireland, allows patients to receive their ultrasound scan and steroid injection where indicated, physiotherapy advice, then consultant review to decide further management. The project aim was to reduce by 25% the length of time of the patient’s journey for those presenting with a shoulder complaint to orthopaedic clinic, from initial appointment until review including investigations and treatment.
Methods
Reviewing 30 patients who underwent shoulder ultrasound established a baseline average waiting time of 26 weeks. Setting our aim using Quality Initiative guidelines was straightforward, as a specific patient cohort was targeted. Numbers were initially small as the clinic runs only twice every eight weeks. A driver diagram was designed to explore the primary and secondary drivers as well as the change ideas. Plan, do, study, act (PDSA) cycles helped develop the project. The clinic was piloted in a satellite hospital before being implemented across other trust sites.
Results
Wait times reduced from 26 weeks to 5.6 weeks. Shoulder ultrasound appointments reduced from 9.4 weeks to 5.6 weeks. Reduction in cannot attend /did not attend rates from 23% to 16%. Physiotherapy patients increased to 88% from 33%. Thirty patients completed a feedback survey with outstanding comments received. 93% of patients responded excellent and 7% responded good to all questions.
Conclusions
Introducing a one stop shoulder clinic reduced patients’ waiting times by 78.46% resulting in a greatly enhanced patient journey, with three separate appointments consolidated into one. Consequently, a financial saving to the trust was made. Due to its success, the clinic was established across other trust sites.