The Implementation of a ´One Stop Shop´ Shoulder Clinic within a Musculoskeletal Triage Service: Assessment, Diagnostic Ultrasound & Guided injections.

Purpose

The purpose of implementing a ´One Stop Shop´ shoulder clinic within the musculoskeletal triage service (CMATS) was to improve the pathway of care for patients with shoulder conditions. This service enables patients to attend 1 appointment and receive a thorough musculoskeletal assessment of their shoulder with immediate access to diagnostic ultrasound scanning, if indicated.

The results are discussed with the patient and a management plan put in place. If indicated an ultrasound guided injection can be performed. This enables the patient to be placed on the most appropriate pathway in a more timely manner, reduces the number of appointments for the patient and reduces the number of referrals into radiology for ultrasound scanning.

As a result of this service being in place the pathway has now changed so that Gp referrals for shoulder ultrasound scanning are being redirected from radiology to this service.

Approach

Implementation of the ´One Stop Shop Shoulder Clinic´ started on 1st April 2019 and data collection is in place. Data is being collected on the number of patients utilising this service, patient satisfaction and the effect on secondary care radiology referrals for shoulder ultrasound scanning.

The planning and implementation of this service has been done in collaboration with radiology services and fully supported by musculoskeletal radiologist. The 2 clinicians involved in this service include an Advanced Practitioner Physiotherapist and a MSK specialist GP. Both clinicians completed a Diagnostic Ultrasound Imaging MSc and then completed competency training under direct supervision of the MSK Radiologist.

The service takes place within the CMATS clinic and referrals from Gp´s for shoulder pathologies are triaged into this service. Patients attend this appointment and receive a thorough assessment of their shoulder and depending on the outcome of this assessment will receive a diagnostic ultrasound scan.

The results of the scan are discussed and if indicated then a guided injection can be performed. By the end of the appointment the patient will have a full understanding of their problem with an appropriate management plan in place.

Outcomes

This service was implemented on 1st April 2019 so data collection is in the very early stages. There will be data available for when the poster requires completion.
 

This is a service that will improve the patient experience and enable the patient to have a thorough understanding of their condition and the appropriate onward management.

Investigations are only being done if clinically indicated and if the results are going to facilitate onward management. This reduces the problems caused by inappropriate investigations.

The pathway for GP access to shoulder ultrasound scanning has changed. GP´s now have to refer into CMATS to access the ´One Stop Shop´ rather than referring directly to radiology for this patient group.

Implications

  • Improve pathway of care for the patient without compromising overall outcome.
  • Less travel time and time off work for the patient to attend 1 appointment compared to multiple previous appointments.
  • Improved patient satisfaction.
  • Reduction of referrals to secondary care radiology services.
  • Reduces inappropriate investigations.
  • This service can be extended to other MSK conditions.

Funding acknowledgements

The diagnostic ultrasound scanner required for this service was purchased from charitable funds provided by Awyr Las.

Additional notes

This work was presented at Physiotherapy UK 2019