Orthopaedics, Sengkang General Hospital, Singapore
NUS Yong Loo Lin School of Medicine, Singapore.
BMJ Open Qual. 2024 Apr 10;13(2):e002670. doi: 10.1136/bmjoq-2023-002670.
The Sengkang General Hospital Orthopaedic Spine Outpatient Service is facing a growing challenge of increasing number of referrals and waiting times, placing a significant burden on the system. Primary care referrals have an average wait time of 61.1 days, with 34.5%f patients waiting longer than 60 days from referral to appointment, to see a spine physician.Back pain is a very common presentation, with the vast majority resolving after conservative management which commonly includes analgesia, physiotherapy and reassurance. Unfortunately, many referrals from primary care involve patients who have yet to explore the avenues of conservative management with 90% of our referrals being managed without surgery. Globally, triage services in Western countries conducted by allied health professionals have shown to be an effective method at addressing the escalating wait times with high satisfaction rates. We have endeavoured to emulate this within our department through the implementation of the Spine Triage and Rehabilitation (STAR) Clinic. The STAR clinic aims to empower physiotherapists with the ability to triage patients into surgical and non-surgical categories with their primary physiotherapy expertise to reduce waiting times and increase outpatient capacity.More than 300 patients were recruited, and their progress was tracked over 13 months under the four Ss of: waiting timeS, cost Savings, Safety and patient Satisfaction. This pilot study has been overwhelmingly positive, with significantly reduced waiting times and high cost savings, without any compromise on patient safety and satisfaction.
盛港综合医院骨科脊柱门诊服务面临着转诊人数和等待时间不断增加的挑战，这给系统带来了巨大的负担。初级保健转诊的平均等待时间为 61.1 天，其中 34.5%的患者从转诊到预约看脊柱医生需要等待超过 60 天。背痛是一种非常常见的表现，绝大多数患者在接受保守治疗后（包括止痛、物理治疗和安慰）都会缓解。不幸的是，许多初级保健的转诊涉及到尚未探索保守治疗途径的患者，我们 90%的转诊患者无需手术治疗。在西方国家，由辅助医疗专业人员进行的分诊服务已经被证明是一种有效的方法，可以解决不断延长的等待时间，并获得高满意度。我们通过实施脊柱分诊和康复（STAR）诊所，努力在我们的部门中效仿这一做法。STAR 诊所旨在通过初级物理治疗专业知识，使物理治疗师有能力将患者分诊为手术和非手术类别，以减少等待时间并增加门诊容量。超过 300 名患者被招募，并在 13 个月的时间里跟踪他们的进展，这四个 S 分别是：等待时间、成本节约、安全和患者满意度。这项试点研究非常积极，等待时间显著缩短，成本节约显著，同时患者安全和满意度没有任何妥协。
