The effects of a new Tendo-Achilles Pathway (TAP) on an orthopaedic department.

Purpose

Achilles tendinopathy is a common pathology that is considered difficult to treat. At a time of austerity in the NHS it is essential to have carefully designed pathways that are monitored in terms of cost and effectiveness. However, a paucity of evidence exists for what the “best value” dedicated “joined up” pathway of care is for this difficult condition. Design, implement and evaluate the impact of a new therapist lead pathway for Tendon- Achilles Pain (TAP).

A quality improvement approach led to the successful
design and implementation of a therapist lead TAP.
TAP provides consistency and equality in care for patients
as well as cost saving for health boards.

Approach

A quality improvement methodology was used. Process mapping, driver diagrams, stakeholder analysis and a series of Plan-Do-Study-Act cycles were used to design and implement TAP. To assess the impact of TAP, data was compared on whole system measures for 46 patients treated with referral to the traditional service (without TAP) and 46 patients managed according to the newly designed pathway (with TAP). A cost analysis was also conducted.

Outcomes

A quality improvement approach led to the successful design and implementation of a therapist lead TAP. The impact of TAP included positive effects on patient satisfaction, a decrease in duplication of treatments, investigations and inappropriate reviews with consultants. No safety concerns were found. TAP was also £44,000 cheaper per annum than the previous service.

Collaboration between orthopaedic and therapy services has resulted in a standardised pathway of care for patients with an Achilles tendinopathy. It has removed unwanted variation, provided an opportunity to monitor the outcomes of treatments and resulted in decreased cost for the health board.

Implications

TAP provides consistency and equality in care for patients as well as cost saving for health boards.

Fund acknowledgements

This project received no grants from any funding agency. ABM University Health Board funded AMH to participate in the Leadership Programme.

Additional notes

This work was published in Musculoskeletal Science & Practice in February 2019, 39:67-72 and presented at Physiotherapy UK 2019.

The Foot and Ankle team are thanked for their input into the designated implementation of the pathway. Academi Wales (medical leadership programme) and University of Wales Trinity Saint David´s for providing training in quality improvement approaches.