TEAMS - towards integration of services
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TEAMS - towards integration of services

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This lecture was given by Dr Rhian Lewis, Consultant in Pain Management from Bangor, North Wales, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. ...

This lecture was given by Dr Rhian Lewis, Consultant in Pain Management from Bangor, North Wales, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".

www.wspg.org.uk

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TEAMS - towards integration of services TEAMS - towards integration of services Presentation Transcript

  • TEAMS - towards integration of services Rhian Lewis Ysbyty Gwynedd Bangor
  • Chaos
  • TEAMS T argeted E arly A ccess to M usculoskeletal S ervices
    • Reorganisation of services
    • Problems encountered
    • Improvements achieved
  • Order
  • Bangor
  • North Wales
  • Challenges
    • Difficulty in coping with referral demand
    • Long waiting lists
    • No acute back pain service
    • Patients on multiple waiting lists
    • Limited co-ordination of services
    • Inappropriate referrals in orthopaedics – low surgical conversion rates
  •  
  • Wider environment
    • WAG programme: Innovations in Care in orthopaedics
    • Project group on accessibility of musculoskeletal services
  • TEAMS working party
    • GP representing local health group
    • Senior manager
    • Orthopaedic surgeon
    • Pain management consultant
    • P hysiotherapist
    • R heumatologist
  • Aims of TEAMS
        • Improved access to services
        • Reduced waiting times
        • Timely surgery
  • Key features
    • Common access point
    • Triage into appropriate specialty
    • Development of care pathways
    • ESP-led Back Pain Service
    • Community-based musculoskeletal clinics
    • Fibromyalgia clinic
  • Integration of services GP referral Triage Surgical advice Chronic back OA/soft tissue Arthritis/CTD Acute back Physio assessment Pain management Rheumat- ology Orthopaedic service
  • Difficulties to overcome
    • Change is threatening
    • Rheumatologists ?Take-over bid?
    • Ortho objected to pooled referrals
    • Delegation of responsibility
    • Supporting new nurses time-consuming
  • Acute back pain
    • New service: ESP (physio) triage
    • Reduce acute backs seen in ortho
    • Screen Red flags (fast-track to ortho)
    • Onward referral of Yellow flags to pain clinic
    • Weekly meeting of ESP with pain clinic MDT
  • Acute back pain pathway Orthopaedics GP Referral Teams Co-ordinator RED Flags ESP screening / telephone Re-assessment Pain Team/Epidural Physio Treatment Resolving D/C Further physio
    • Telephone reviews
    • TENS and drug reviews by specialist nurses
    • Greater emphasis on education, exercise and self-management
    • Flare-up protocols
    • Weekly MDT meeting
    Chronic pain - changes
  • Pain clinic - staff increases
    • 3.5 Consultant sessions
    • 0.5 Specialist nurse
    • 0.5 Psychologist
    • 0.5 Physiotherapist
  • Chronic pain - results
    • Increased throughput – 400 -> 700/year
    • Waiting list of 2-3 months (down from 12 months)
    • Acute referrals from ESP seen within 1 week
  • Rheumatology - changes inflammatory triage GP referral non-inflammatory rheumatology musculoskeletal
  • New programme - GPwSI
    • 5 GP's with an interest in MSM
    • Work closely with ESP Physio
    • Triaged by rheumatology consultant
    • Overseen by clinical lead
    • Treatment of uncomplicated musculoskeletal problems
  • Musculoskeletal clinics
    • One clinic weekly in each geographical area
    • Bangor, Llandudno, Holyhead, Pwllheli, Dolgellau
    • 125 patients a month
    • Monthly combined education programme
  • Rheumatology - results
    • Reduced waiting times
    • Greater responsiveness to patients
    • More use of nurse-led, multidisciplinary review clinics
    • Telephone helpline
  • Orthopaedics - changes
    • LBP seen by ESP
    • Musculoskeletal to GPwSI and ESP
    • Reduction in out-patient waiting times
    • Surgical conversion increased to 60%
  • Educational meetings
    • Physio
    • GPwSI
    • Ortho trainees
    • A and E staff
    • GPs
  • Results in first year (2002)
    • Total monthly referrals 400 --> 900
    • Orthopaedic share 250 --> 200
    • Increase in pain, MSM, physio
    • Abolished duplicate referrals
    • Surgical conversion rate improved
  • Waiting time reductions (weeks) 2001-2002
    • T and O
    • 52 --> 13
    36 --> 9 52 --> 7 Pain Rheumatology
  • Current position 2007
    • Improvements maintained
    • Referrals 890/month
    • Waiting times maintained
  • Pain clinic perspective
    • Back pain service in place
    • ESP and Pain clinicians
    • Increase in:
      • semi-acute backs
      • MRI scans
      • tertiary referrals
  • What did we learn?
    • Integration improves services
    • Community clinics effective for uncomplicated musculoskeletal problems
    • Nurse-led clinics can reduce W/L
    • Acute back pain service valued by GPs
    • Helpline valued by patients
  • TEAMS - the answer?
    • One-stop shop for patients
    • Joined up services for practitioners
  •