The FirstHand innovation project: a therapist-led plastic surgery waitlist clinic to improve the current patient plastic surgery pathway and enable patients to receive the best care within the best timeframe.
Dana Parkin1 1Royal Perth Hospital, Perth, WA, Australia
Abstract
Introduction: Patients with chronic hand conditions, referred to Plastic Surgery, wait up to 12 months for an initial appointment to see a consultant. This is longer than clinically recommended for an initial specialist appointment. With the COVID outbreak, new appointments were delayed by restrictions on face-to-face appointments. Elective Plastic Surgery theatre waitlists were also backlogged by the COVID restrictions, especially for category 2 and 3 cases.
Method: This led to a waitlist pilot project, the Firsthand clinic being trialled between January and October 2022. A new model of care was implemented whereby patients from the Plastic Surgery waitlist were first seen by a senior hand Occupational Therapist (OT) prior to seeing the consultant and a management plan developed. Often times the consultant prefers to trial a period of conservative management prior to booking the patient for surgery, which streamlined this process. The senior OT leading the Firsthand clinic, screened the E-referral database and identified chronic hand conditions of carpal tunnel, DeQuervains, trigger finger/thumb, and 1st CMC OA for treatment. This enabled surgeons to review more urgent or complex patients in more appropriate timeframes.
Results: With 105 patients seen in the FirstHand clinic, 30% were discharged after their initial appointment, 42% were booked with a consultant, and 8% were rebooked with Firsthand clinic for one follow up review. The Firsthand clinic had only 16% of patients who did not attend their initial appointment. Of the 44 patients seen by the consultant, 54% went on the surgical waitlist at first review, and 36% were discharged from the first consultant review.
Discussion: The OT-led clinic had positive outcomes. Patients benefitted from earlier intervention and facilitation of self-management strategies and Plastic Surgery realised $90/per patient cost savings with reduced consultant appointments. The Firsthand clinic demonstrates successful outcomes made possible through therapist and consultant collaborations.
Biography
Dana Parkin graduated from Curtin University in 2012 after completing a Bachelor of Science Occupational Therapy degree. She later went on to complete a Masters of Health Professions Education through the University of Western Australia. Dana has been working at Royal Perth Hospital since 2015 and is currently a senior occupational therapist in the plastic surgery outpatient clinic, running telehealth rural and remote clinics as well as an outpatient discharge clinic alongside the plastic surgeons.