Advanced Practice AHP expertise in Action: Advanced Practice Physiotherapist Triage and Assessment Clinics for routine Rheumatology referrals and reviews
Carol McCrum1,2 1Canberra Health Service, Canberra, ACT, Australia2University of Brighton, Eastbourne, East Sussex, United Kingdom
Abstract
Background: Rheumatology referrals classified as non-urgent/routine or non-inflammatory conditions had significant wait-times for appointments, escalated by COVID19. Early intervention for non-inflammatory conditions is also crucial and long wait-times have significant adverse impacts. Non-medical Advanced Practice Allied Health expertise in assessment and care pathways can enhance right time, right care service delivery but has limited utilisation.
Aim: Evaluate impacts and patient experiences of Advanced Practice Physiotherapist (APP) Triage and Assessment Clinics seeing non-urgent/routine Rheumatology referrals and reviews.
Methods: APP e-triaging of referral waitlists identified referrals suitable for APP Rheumatology clinics using triage criteria and clinical record searches. Triage clinics had collocated Consultant supervision and pathway support. With wait-list attrition, clinics then included Consultant-determined stable patient reviews.
Results: Between July 2021- December 2022, 342 new Category 3 referrals (n=103-waiting>2yrs) and 16 new Category 2 referrals were triaged to the APP clinic. In addition, 95 reviews of stable inflammatory patients were undertaken. Triage and assessment clinic outcomes include: 69% (n= 243/358) discharged to GP or directed to right pathway with information/advice and self-management resources; 8% (n=29/358) escalated to urgent; and 4% (10/358) remained on Consultant wait-list due to medical complexity. To date, no patients have been re-referred and 329 Consultant Initial and 95 Follow-up appointments have been saved. There is currently no wait-time for non-urgent/routine referrals and support continues for stable patient reviews. Patient experience feedback expressed 100% recommendation and highly positive experiences of the service. Consultant time was required for clinical discussions, input and governance, and diagnostics (pathology/imaging) currently requiring co-requesting.
Conclusions: Rheumatology referrals with low probability of autoimmune conditions and stable condition reviews may be safely, effectively and efficiently managed using Advanced Practice AHP experience and skills. This multidisciplinary innovation expands on medical/nurse delivered pathways and demonstrates benefits of utilising AP expertise for enhancing access, service efficiencies, interdisciplinary learning and collaboration.
Biography
Dr Carol McCrum was a Consultant Physiotherapist in Musculoskeletal Medicine, Orthopaedics and Rheumatology in the NHS and is now based at Canberra Health Services. Carol completed her doctorate in 2011 and is a Visiting Research Fellow, University of Brighton and research collaboration with University of Canberra. Carol is involved in regional, national and international Rheumatology and Advanced Practice projects including the NICE Guidance on Spondyloarthritis, receiving a NICE Fellowship in 2017, and WHO RA Rehabilitation guidance. Carol is keen to support a national approach to enabling advanced AHP practice to enhance access and care pathways in the Australian healthcare context.