Patients with spinal pathologies can range from simple mechanical low back pain to complex pathology requiring urgent medical or surgical intervention. The national low back pain pathway recommends the use of 'triage and treat' practitioners working at an advanced level to manage the majority of these patients, yet the skill mix of such services varies throughout the country resulting in delays for complex patients and unnecessary waits for surgical services for others who could be adequately managed conservatively.
In a local triage and treat service, to ensure referrals through to a tertiary spinal surgical centre are appropriate and patients get the correct advice early in their management pathway a Consultant Physiotherapist working for spinal services provided weekly clinical based case discussions to the 'triage and treat' practitioners for one CCG. The outcomes for patients who were discussed and referred through to tertiary spinal services were reviewed retrospectively and compared to the outcomes for referrals from other CCGs with 'triage and treat' services and no case based discussion. The number of patients discharged on the first appointment with the tertiary spinal service were compared between the two groups to see if more appropriate patients were referred into spinal services when the triage and treat practitioner was able to clinically reason through the case with a Consultant Physiotherapist.
Patients referred from triage and treat or other interface services without a consultant physiotherapy case based discussion were twice as likely to require further work up such as investigations; or be discharged from clinic on their first attendance than those who had been through the case based discussion with a consultant physiotherapist.
A Consultant Physiotherapist working as part of the spinal team of a tertiary referral centre can aid advanced practitioners with their clinical decision making which is likely to prevent unnecessary referrals to spinal surgical services and ensure patients referred to spinal surgeons have appropriate investigations prior to the initial appointment.
It would be helpful when commissioning triage and treat or interface services to consider the benefit of Consultant Physiotherapy level input; this may aid the patient journey for complex patients whilst developing the knowledge and clinical reasoning of the advanced practitioners. With the ongoing development of advanced practice roles this may aid the ongoing development and value of the physiotherapy profession. Sharing the project with physiotherapists will allow senior staff to link with commissioners to advance the opportunities within the profession.
No funding was obtained to complete this work; however the mentorship and support of Dr Susan Greenhalgh (Consultant Physiotherapist) must be recognised.
This work was presented at Physiotherapy UK 2019