Neurosurgical virtual clinic outcome review - Getting it right first time

Purpose

A Neurosurgical virtual clinic (NVC) was established due to the closing of local spinal services and the need for an improved pathway between a community interface service (Cambridgeshire Community Services NHS trust) and the secondary neurosurgery service (Cambridge University Hospitals NHS Trust). Building on the NHS Long Term plan, utilising the get it right first time (GIRFT) ethos the clinic was led by an Advanced Practitioner (AP) alongside a neurosurgeon working as a collaborative to maximise and target patient care and minimise wait, excess appointments and duplicated assessment.

54% of patients
Avoided unnecessary referral to secondary care neurosurgery appointments through use of the virtual clinic.

Approach

Service evaluation - 2 years of NVC data has been collected via weekly virtual clinics between organisations. Cases were discussed in a local clinic between AP staff, with images present. If deemed appropriate locally cases were presented at the NVC. Management plans were optimised during this process, with outcomes of the discussions fed back to patients following NVC via telephone consultation in a timely manner.

Outcomes

Results: 454 patients were reviewed. 136 patients (30%) were offered a referral to Neurosurgery preadmission clinic for surgical intervention. 124 (27%) patients had a non surgical presentation. 54 patient (13%) were offered a referral for a nerve root block. 46 patients (10%) were referred to a consultant clinic with 27 patients (6%) referred to pain clinic. The remaining 64 patients (14%) had a collection of outcomes including no MRI scan to view, non-spinal pathology or requiring further imaging. Out of the 136 patients that were offered a referral for a surgical intervention 21 patients declined a referral for surgery and 9 patients were untraceable. 106 patients were referred for surgical intervention with 98 patients having a surgical operation and 8 patients were declined surgery. Out of the 54 patients that were offered a referral for a nerve root block, 9 patients declined the procedure and 4 patients had multiple reasons declining NRB. The remaining 41 patients under went NRB with 23 patients not requiring further interventions, 12 patients subsequently undergoing spinal surgery and 8 patients subsequently referred to pain clinic.

Conclusion(s): The NVC successfully led to 54% of patients avoiding unnecessary referral to secondary care neurosurgery appointments (n= 245). The implementation of NVC additionally led to faster access to patients requiring surgical intervention or NRB. Conversion rate to surgery also improved with 92% of the patients referred to surgery undergoing surgical intervention. Introducing a NVC supports the GIRFT ethos and has streamlined the pathway for neurosurgical intervention.

Cost and savings

No further data 

Implications

Utilizating a AP and consultants time has improved the efficiency of the spinal pathway enabling patients to receive timely access to consultant opinion without the need to travel to hospital. NVC is a cost efficient service improvement which can be easily implemented into a spinal pathway. This service evaluation could be used as a case study within NHS policy documents and is supported by GIRFT ethos and NHS long term plan.

Top three learning points

No further data

Funding acknowledgements

None