Mr Kenny Kessler1
1Royal Perth Hospital, Perth, Australia
Patients with foot and ankle pathology are referred for orthopaedic surgical evaluation at Royal Perth Hospital. Increasing volume of referrals and limited availability of sub-speciality surgeons has resulted in an increasing waitlist, delaying patient’s access to care. Delay in care causes decreased patient satisfaction, prolonged periods of pain and negatively impacts on quality of life.
In response, an advanced scope physiotherapist (ASP) was integrated into the orthopaedic foot and ankle service to assess and identify patients who are unlikely to benefit from surgery, implement an evidence based non-surgical management plan where appropriate, and refer those who may benefit from surgery for surgical consultation.
28.5% of patients waiting on the category 3 waitlist were triaged into the ASP led clinic. 114 new patients were seen by the ASP in an 8-month period. The average time patient’s had waited from point of referral was 740 days. Most common patient presentations seen included chronic ankle instability, recalcitrant plantar fasciitis, and talocrural osteoarthritis. 70% of patients were managed independently by the ASP, and 30% of patients required consultation with the orthopaedic specialist. 50% of patients seen by the ASP were discharged from clinic after initial assessment. At time of audit, conversion to surgery was 2%, whilst 36% of patients were currently undergoing non-surgical management and awaiting review by either the ASP or surgeon. No reported adverse patient outcomes.
The integration of an ASP into the elective foot and ankle orthopaedic service provides a safe and timelier pathway for patients to access appropriate care. This provides further evidence to support the expansion of suitably experienced physiotherapists roles in various orthopaedic sub-specialty areas.
Kenny is a postgraduate titled musculoskeletal physiotherapist working as an advanced scope physiotherapist across orthopaedics, spinal orthopaedics and emergency department specialities. His research interest lies in improving the implementation of high value, best practice care within the emergency department for patients with musculoskeletal conditions.