Rymaszewski L A, Sharma S, McGill P E, Murdoch A, Freeman S, Loh T
Stobhill Hospital, Glasgow, UK.
Ann R Coll Surg Engl. 2005 May;87(3):174-80. doi: 10.1308/1478708051793.
The majority of patients with musculo-skeletal problems referred to hospitals in the UK have to wait for months, if not over a year, before finally seeing an orthopaedic surgeon. In Stobhill Hospital, Glasgow, the waiting time for an out-patient appointment was 182 days in 1995, with only 20% of the referrals requiring surgery. The aim of this paper was to reduce the out-patient waiting times based on a co-ordinated team approach.
An outpatient musculo-skeletal service was developed over a 7-year period at Stobhill Hospital. The traditional consultant-based model, in which the consultant and a trainee saw all new patients referred to the hospital, was gradually replaced with a team approach, based on continuous reconfiguration of the roles of the orthopaedic surgeon and rheumatologist and extending the roles of nurses, physiotherapists and podiatrists. This was achieved by: (i) protocol-based daily triage for all referrals to the most appropriate health professional in the team, by the senior out-patient nursing staff; (ii) allocation of appointments based on clinical priority, with a fast-track for urgent cases; and (iii) improvement of inter-disciplinary communication, facilitating the retraction as well as the extension of traditional roles.
Despite the number of GP referrals to the orthopaedic out-patient department at Stobhill nearly doubling in a period of 5 years, the out-patient waiting time decreased by about 50% (90 days from 182 days). This reduction in waiting times improved patient and GP satisfaction levels. We also noticed an improved morale and personal development of the health professionals as they saw patients appropriate to their skills and expertise.
The team's experience demonstrates the effectiveness of a team approach in tackling what is often seen as the insoluble problem of orthopaedic waiting times. This is based on excellent communication and collaboration, with a clear aim of improving patient care that is evidence based.
在英国，大多数因肌肉骨骼问题前往医院就诊的患者要等待数月甚至一年以上才能最终见到骨科医生。1995年，格拉斯哥斯托比尔医院的门诊预约等待时间为182天，其中只有20%的转诊患者需要手术治疗。本文旨在通过团队协作的方式减少门诊等待时间。
斯托比尔医院在7年时间里建立了一个门诊肌肉骨骼服务体系。传统的以顾问医生为主的模式，即顾问医生和一名实习生接待所有转诊到医院的新患者，逐渐被一种团队协作模式所取代，这种模式基于对骨科医生和风湿病学家角色的持续重新配置，并扩大护士、物理治疗师和足病医生的职责。实现这一目标的方式包括：（i）由资深门诊护理人员根据协议对所有转诊患者进行每日分诊，将其分配给团队中最合适的医疗专业人员；（ii）根据临床优先级安排预约，为紧急病例开辟快速通道；（iii）改善跨学科沟通，促进传统角色的缩减以及职责的扩展。
尽管在5年时间里，转诊至斯托比尔医院骨科门诊的全科医生（GP）转诊量几乎翻了一番，但门诊等待时间却减少了约50%（从182天降至90天）。等待时间的缩短提高了患者和全科医生的满意度。我们还注意到，随着医疗专业人员看到与他们技能和专业知识相匹配的患者，他们的士气和个人发展也得到了提升。
该团队的经验表明，团队协作模式在解决骨科等待时间这一通常被视为无法解决的问题方面是有效的。这基于良好的沟通与协作，其明确目标是以循证为基础改善患者护理。
