See & Treat Ultrasound Foot Clinics

Mr R D Ferdinand

What will we explore?

• S• B• A• R• Unexpected outcomes

Situation

Situation

• More than 5 hospital appointments to gain diagnosis

• Patient pathway prolonged• System blocks to patient flow• Inappropriate tests• Perceived low patient satisfaction

Background

• Single surgeon service• Large catchment area• Understaffed Radiology service• 12 years in post• No ultrasound experience

Action

• One stop concept• Identify unused machine time• 2 day training course in Newcastle• Alter triage, educate colleagues• 1 in 7 weeks, 30 min slots• Audit outcome

Example 1

• New Pathway– S & T clinic USS, Injection, Definitive treatment

Examples• Achilles insertional enthesopathy• Subtalar injection• Peroneal tear• Symptomatic Os Trigonum• Talonavicular injection• Tarso-metatarsal injection• Sesamoid pain• Morton’s neuroma• Plantar fibromatosis• Esoteric

Results

• Dramatic reduction in patient journey• High patient satisfaction• 32 MRIs avoided• 23 anaesthetics avoided• 1 in 7 weeks insufficient• Cost

Unexpected outcomes

• Joint injection• Achilles tendon planning• Morton’s neuroma accuracy• Dynamic peroneal tendon assessment• Ankle block accuracy• Job satisfaction• Clinic time freed for extra surgery

Any Questions?