Implementation of a Virtual Spinal Clinic (VSC) for patient´s with acute spinal pathology.

Purpose

To develop a VSC for patients with acute spinal pathology to provide timely virtual follow-up for patients across Greater Manchester. The clinic was a Consultant led clinic run by a Consultant Physio and Trainee Advanced Physiotherapist Practitioners. To achieve early onward referral whilst improving patient satisfaction and preventing risk of spinal chronicity.

Completed outcomes of VSC:
41% Discharged

45% Routine clinic appointment

14% Urgent appointment
Other outcome:
61% Completed outcome

5% Telephone review

20% Recycled to future VSC due to outstanding investigations

14% Referral not appropriate
...VSC provided patients with timely,
safe and early management plans and advice via telephone call consultation.
Patients reported that the early telephone consultation
was reassuring and allowed them to return to previous function earlier.

Approach

A 3-month pilot of the VSC was completed. A VSC pathway was developed, patients were referred to the VSC from the on-call service and patients diagnosed with spinal fracture, radiculopathy, myelopathy, discitis or spinal tumour were to be accepted.

The VSC ran twice a week with the on-call Consultant providing 1-hour of their time for the VSC. Patients scans and investigations were reviewed in the MDT clinic, a management plan was developed and then the Consultant Physio or Trainee Advanced Physiotherapist Practitioner would contact the patient or local hospital with the management plan.

The patient outcome was either discharge from the spinal services with appropriate follow up, routine follow-up appointment with the consultant, urgent appointment with the consultant or telephone call review in 6 weeks.

Outcomes

** 3 month trial finishes next week so results may change slightly **

 

  • 23 clinics completed
  • 271 patient contacts
  • 216 seen virtually in the clinic
  • 11.6 days time from on- call referral to review in virtual spinal clinic

 

Demographics:

  • 54% Female 46% Male
  • Average age - 54
  • Average age over 65 - 68

 

Present conditions seen: 70% fracture, 11% radiculopathy, 8% spinal infection 5% cauda equina syndrome, 3% myelopathy and 3% spinal tumour

 

Completed outcomes of VSC:

  • 41% Discharged
  • 45% Routine clinic appointment
  • 14% Urgent appointment

 

Other outcome:

  • 61% Completed outcome
  • 5% Telephone review
  • 20% Recycled to future VSC due to outstanding investigations
  • 14% Referral not appropriate

 

Outcome from telephone follow up:

  • 73% Discharged from spinal services
  • 7% Routine clinic
  • 7% Urgent appointment
  • 13% Recycled into VSC

 

Patient feedback: Multiple complements from patients with improved patient satisfaction.

 

The VSC was able to successfully complete safe and timely assessments, management plans, patient telephone consultations and onward referrals for Greater Manchester patients with acute spinal pathology. A large proportion of the patients had a diagnosis of acute spinal fracture. Patients were reviewed in VSC on average 11 days after referral with the outcome of 41% of patients being discharged from the Complex Spinal Service.

This confirms that the VSC provided patients with timely, safe and early management plans and advice via telephone call consultation. This allowed patients to have earlier access to a health professional to provide advice, reassurance, complete onward referrals and safety netting advice.

Patients reported that the early telephone consultation was reassuring and allowed them to return to previous function earlier.

Implications

The earlier telephone call not only reduced patients waiting time for a follow up clinic appointment but it reduced patients travel time across Greater Manchester for a routine appointment. The 6 week follow-up telephone call service was not utilised as much as previous thought and in the future it is hoped that this element of the pathway will be developed further.

Fund acknowledgements

Complex Spinal Team - Salford Royal.

Additional notes

This work was presented at Physiotherapy UK 2019.