CHHS17/043

Canberra Hospital and Health ServicesOperational Procedure Outpatient Orthopaedic – Physiotherapy Led Triage Clinics Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Procedure................................................................................................................................. 2

Patient Triaging and Allocation.............................................................................................2

Physiotherapy-led Outpatient Orthopaedic Triage Clinic – Assessment...............................2

Patient Arrival....................................................................................................................... 2

Assessment...........................................................................................................................2

Criteria for ordering further investigations...........................................................................3

Criteria for consultation with orthopaedic surgeon or consultant rheumatologist..............4

Communication with referring Doctor..................................................................................4

Implementation........................................................................................................................ 4

Related Policies, Procedures, Guidelines and Legislation.........................................................4

References................................................................................................................................ 5

Definition of Terms...................................................................................................................5

Search Terms............................................................................................................................ 5

Attachments..............................................................................................................................5

Attachment A – Physiotherapy Assessment Form................................................................6

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support1 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/043

Purpose

The purpose of this Operational Procedure is to define the way in which the patients in the Physiotherapy-led Triage Clinics are managed.

Back to Table of Contents

Scope

Scope

These procedures apply to patients referred to Orthopaedic Surgical Outpatients for conditions referred for consultation with Orthopaedic Specialists at Canberra Hospital and Health Services CHHS.

This procedure applies to physiotherapy staff who have completed or are undertaking Advanced or Extended Scope Practice training (see definition below). Hereafter, both will be referred to as ‘ESP physiotherapist’.

Back to Table of Contents

Procedure

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support2 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

This Standard Operating Procedure (SOP) describes for staff the process to

CHHS17/043

Assessment ESP physiotherapist evaluates the patient. If red flags are identified in the assessment the consultant/registrar will be contacted and

requested to review patient as required. If no red flags – proceed with subjective and objective assessment. This includes review

of radiology and blood test results (as appropriate). Abnormal results will be actioned within the scope of practice of the ESP Physiotherapist, or the consultant/registrar will be contacted and requested to review patient as required.

For Subjective assessment see assessment form Attachment A

Standard physiotherapy subjective assessment to include: Body chart (or appropriate description of location of symptoms) Aggravating/easing factors 24 hour behaviour of symptoms Screening questions specific to patient History of condition and previous interventions Past medical and surgical history Evaluation of current patient medication

Objective examination (AS APPROPRIATE) (see assessment form Attachment A) Active movements of the affected area/s and surrounding structures as indicated Passive movements of the affected area/s and surrounding structures as indicated Neurological exam as indicated by region of symptoms

o Dermatomal sensationo Muscle powero Upper and/or lower limb reflexes as indicated

Upper limb and/or lower tension tests as indicated Palpation of the affected area/s as indicated Any additional specific tests the attending physiotherapist deems applicable

ESP physiotherapist to liaise with other health professionals (as required) to discuss findings, write notes and plan onward referral.

Patient informed by ESP physiotherapist of their diagnosis (if able to be determined) and the nature of their condition. Management of condition/treatment plan to be discussed with patient. Obtain consent to proceed or amend plan.

If patient is to be referred for further investigation, referral is completed whilst the patient is present and the patient is advised to attend for radiology/pathology investigation as appropriate.

If referred for conservative treatment the appropriate referral form is completed or patient is referred to main care giver e.g. General Practitioner (GP) for co-ordination of ongoing health care management.

If patient requires a surgical opinion this will be organised accordingly through the booking and scheduling staff.

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support3 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/043

Criteria for ordering further investigations To assist with establishing the patient diagnosis, or to ensure appropriate investigations

have been completed prior to consultant appointment. ESP physiotherapist will order X-ray/USS/CT/Bone Scan/MRI/MRA/blood screening tests

(in consultation with the orthopaedic surgeon or consultant rheumatologist if required). Patients will be followed-up in the physiotherapy-led clinic or with a medical or surgical specialist subsequent to any further investigation.

Criteria for consultation with orthopaedic surgeon or consultant rheumatologistDiscussion will occur (as appropriate) between ESP physiotherapist, GP and a consultant under the following circumstances: Concerns regarding patient answers to `red flag’ screening questions or such findings

during the assessment. Before ordering further investigations as appropriate (as described above) Marked abnormalities on existing x-ray, ultrasound/CT/MRI, correlated with severe

functional impairments found on assessing the patient. For discussion of blood test results. Need for pharmacological review, including history of significant use of pain medication.

The patient’s GP is best placed to modify medications. The need for a pharmacological review should be communicated back to GP via the standard letter.

Regarding urgency of surgery.

Communication with referring DoctorESP physiotherapist is to correspond with referring Doctor outlining main assessment findings, decisions regarding urgency for surgery and referrals to allied health. A copy of correspondence is to be filed on patient’s clinical record.

Back to Table of Contents

Implementation

The procedures will be incorporated into the training pathway for new staff commencing their role in the Physiotherapy-Led Orthopaedic Clinics. All staff conducting the clinics will be provided a copy of the procedure for their reference and copies are accessible by all staff via the CHHS intranet.

Back to Table of Contents

Related Policies, Procedures, Guidelines and Legislation

Policies Consent and treatment

Guidelines Triaging of Outpatient Referrals for Consultation with Orthopaedic Specialists Clinical

GuidelineDoc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support4 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/043

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011

Back to Table of Contents

References

Leonie B Oldmeadow; Harvinda S Bedi; Hugh T Burch; Jenni S Smith; et al; Medical Journal of Australia; Jun 18, 2007; 186, 12

Back to Table of Contents

Definition of Terms

Advanced/Extended Scope Physiotherapist in TrainingA physiotherapist with extensive experience in providing expert musculoskeletal assessment, diagnosis and appropriate onward management for patients presenting with chronic and/or acute pain to an Outpatient Clinic. This is a training role working under supervision whilst advanced/extended scope competencies are achieved.

Orthopaedic PatientPatients with orthopaedic conditions referred to outpatients by a medical practitioner for the assessment and management of a musculoskeletal condition.

Back to Table of Contents

Search Terms

Physiotherapy, Orthopaedic, Triage, Outpatient, Clinic

Back to Table of Contents

Attachments

Attachment A – Physiotherapy Assessment Form

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved By08/12/2016 All

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support5 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/043

Attachment A – Physiotherapy Assessment Form

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support6 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/043

Doc Number Version Issued Review Date Area Responsible PageCHHS17/043 1 16/03/2017 01/02/2020 Medicine – Acute

Support7 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register