Background
Spinal pain management guidelines emphasise the importance of triage to differentiate conditions requiring non-surgical management from the more serious conditions potentially requiring specialist referral. Neurosurgeons are called upon when patients exhibit serious neurological or deteriorating symptoms in order to potentially perform surgery to improve patient outcomes. Lengthy wait times for specialist appointments lead to a delay in patients’ accessing appropriate and timely care. This study is part of a larger translational research framework looking at service re-design to utilise specialist services more efficiently and improve patient care.
Aims
The aim of this study was to describe current processes of care for patients referred to a public hospital outpatient neurosurgery clinic for spinal pain management.
Methods
A retrospective review of 277 medical records for patients referred to an outpatient neurosurgical clinic was conducted over a 12-month period. Demographic data, referral sources, wait times, attendance, and assessment and management procedures were collected. Data were analysed using descriptive statistics.
Results
Patients waited a median (IQR) time of 166.5 (268.0 – 86.0) days for an initial appointment and over a third (39%) of patients did not attend their initial appointment. No patient was categorised as having a serious pathology and the majority (63%) had non-specific spinal pain. Of the patients who attended their appointment, only 13% were offered surgery, 31% were referred on for physiotherapy, and a further 19% were discharged with no further management recommendation. Screening for red (61.5%) and yellow flags (81.8%) was not evident in the majority of files.
Conclusion
Many patients referred to the clinic do not require specialist intervention for their spinal pain. Poorly directed referrals and lengthy wait-times delay conservative care and place an unnecessary burden on the neurosurgical clinic. This presents a unique opportunity to engage stakeholders and move towards a re-design of service delivery to improve care for patients with spinal pain as well enhancing the productivity of the neurosurgical clinic.