Successfully reforming orthopaedic outpatients

Abstract

Since 2005, Barwon Health has successfully reformed its orthopaedic outpatient service to address the following issues: increasing number of referrals, inefficient referral management and triage, long waiting times for non-urgent appointments, high ‘Did Not Attend’ (DNA) rates and poor utilisation of conservative therapies before referral to surgeon. Numerous strategies have been implemented including: waiting list audits, triage guidelines, physiotherapy-led clinics, a DNA policy, an orthopaedic lead nurse role and a patient-focussed booking system. There has been a 66% reduction in the number of patients waiting for their first appointment; an 87% reduction in the waiting time from referral to first appointment; a 10% reduction in new patient DNAs; and more efficient referral management and communication processes. Patients are now seen in clinically appropriate time frames and offered earlier access to a wider range of conservative treatments.

What is known about the topic? Demand for public outpatient services continues to increase. New resource and budget availability is limited, so organisations must continually look for ways to utilise existing resources as efficiently and effectively as possible to deliver timely and appropriately patient care.

What does this paper add? Further evidence that redesign work that addresses both the administrative and clinical aspects of outpatient services can achieve positive and sustainable outcomes. Alternative models of care such as physiotherapy-led screening clinics, which utilise the skills of a range of health professionals, can supplement traditional medical-led clinics to provide high quality patient care and reduce the workload on consultants. Administrative changes such as patient focussed bookings can be implemented without compromising patient care and may simultaneously reduce the administrative load for the organisation and encourage patients to become more active and responsible participants in their own care.

What are the implications for practitioners? Redesign work needs to consider both the clinical and administrative aspects of outpatient care, in order to implement sustainable change that positively affects the patient journey. The effects of change on upstream and downstream providers needs to be considered before changes are made. Transparency of the change of management process is vital, no matter how confronting this may be for stakeholders, to ensure decisions are based on fact, rather than hearsay or historical practice.