A Model of Spinal on Call: Orthopedic Spinal Rapid Access Service: Results of 6-Month Prospective Audit

Abstract

Introduction Provision of structured on-call rota for spinal conditions can be challenging in the most orthopedic department because of the limited number of spinal surgeons. Spinal emergencies are therefore managed often by general orthopedic surgeons with potential of suboptimal outcome. Spinal conditions are managed in our institute with a team of spinal surgeons and nonmedically qualified spinal clinicians. Orthopaedic Spinal Rapid Access Service (OSRAS) was developed in our institute to provide a structured pathway for management of urgent spinal pathologies during working hours of Monday to Friday. It was delivered through a published rota by a multidisciplinary team of nonmedically qualified spinal clinicians carrying a bleep and a spinal surgeon. Aim This study aims to evaluate the efficacy of OSRAS through a prospective audit. Materials and Method New service development protocol was followed and board approval for this project was obtained. A spinal on-call rota was designed and was published to limited number of clients. The data obtained for all patients who were referred to the OSRAS services were collected prospectively in a predesigned performa that was approved by the audit department in our institute and analyzed. Results Between Nov 2013, 1, and April 30, 2014, 177 patients (48 males and 119 females) with an average age of 50 (range, 17–95 years) years were referred to OSRAS. Wednesday was the busiest day with 26% referral in AM and 74% in PM. Main source of referrals were as follows: regional MSK services (50), triage (34), ED (27), and GPs (20). The reasons were as follows: suspected CESI ( n = 100), acute LBP ( n = 30), pathological fractures ( n = 23), progressive neurology ( n = 16), discitis ( n = 5), and spinal stenosis ( n = 2). Depending on clinical needs, 29 patients were seen on the same day, 33 next day, 53 within 2 to 5 days, and 31 patients more than 5 days. Overall, 80 patients were discharged, 36 listed for surgery, 27 required further follow-up, and 31 patients were given telephone advise only. High user satisfaction rating was obtained. Conclusion We propose an OSRAS model as a safe and cost-effective alternate to often unsatisfactory current emergency department model that can provide a structured pathway for timely expert management of serious spinal pathologies therefore prevent potential consequences while avoid unnecessary admissions.