Open Access

Brigitte Tampin, S. Mitchell, A. Walton, R. van der Linden, M. Lam, T. Hebden-Todd

• Background and Aims With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment, there is a call to support innovative models of care1, including the timely evaluation and expansion of workforce models supporting advanced practice skills in allied health. An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2 full time equivalent) examine patients referred with spinal pathology from the Neurosurgery waitlist for their suitability for spinal surgery and instigate work-up where required, and for evaluation by a Neurosurgeon or appropriate non-surgical management. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. The ASPs work autonomously and they discuss patient cases with a neurosurgery consultant on a weekly basis, as required. The aim of this project was to evaluate the ASP service in the year 2022 and 2023. Method A retrospective descriptive analysis of patient data captured in 2022 and 2023 was performed. Results • Patient Management: In 2022, 1337 new patients were managed along with 267 follow-ups. Most patients received their initial appointment within the recommended wait times (Category 1 within 1 months, Category 2 within 3 months, category 3 within 12 months). • ASP Autonomy: Of the new referrals, 849 (64%) did not require discussion with a consultant, emphasizing ASP's capacity for independent clinical decision-making. • Patient Outcomes: Of the 1317 patients assessed by ASPs, 57% were discharged immediately post-assessment, while outcomes for 290 patients (22%) were pending as of January 2023. • Neurosurgeon Referrals: Only 281 (22%) of patients assessed by ASPs were referred to a neurosurgeon, of which 103 (45%) were offered surgery. • Further detailed outcomes will be analysed and presented in 2024, incorporating 2023 data. Conclusion Only 17% of the 1604 patients managed by the ASPs needed to see a Neurosurgeon. The conversion rate to surgery of 45% compares well with an estimated 5%-10% in a non-triaged Neurosurgeon clinic and highlights the benefits of triage work-up and screening prior to review by the surgeon. The ASP model of care has proved invaluable to (i) provide timely access of patient care within the recommended wait times (ii) optimize Neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management, (iv) reduce the inconvenience and cost of travel for patients in remote areas using telehealth. References Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia