Connecting to you: Introduction of a Telephone Follow-Up Clinic for Orthopaedic patients undergoing steroid injection treatments.

​Name
Barbara Earnshaw 

Role
Trainee Advanced Nurse Practitioner: Trauma & Orthopaedics 

Place of work
Fracture Clinic, East Lancashire Hospitals NHS Trust 

Background  
The CQC (2014) highlighted that Outpatient Services within East Lancashire Hospitals NHS Trust (ELHT) were not responsive to the needs of its population. The Trauma & Orthopaedic (T&O) Directorate within ELHT provides elective steroid injection treatments to an average of 1200 patients per year. These patients are followed up face-to-face with the Consultant in the Orthopaedic Outpatient Department.
 
As this procedure is minimally invasive, patients could be safely reviewed post-procedure via telephone consultation by an Advanced Practitioner (Wilson & Bickerdike, 2015; Department of Health [DH], 2010). Role substitution would enable the Consultant to focus on more complex patients whilst having a positive impact on clinical flow within the T&O Directorate.
 
Aim  
To revise the existing outpatient follow-up service for Orthopaedic patients who undergo elective steroid injection treatments by introducing a Telephone Follow-Up Clinic.
 
Methods

• Kotter’s (1996) Eight Step Theory for Leading Change utilised to manage change
• Elective Orthopaedic steroid injection treatment process analysed highlighting current gaps in service provision
• Potential service improvements identified
• The effectiveness of Advanced Practitioner telephone consultation and role substitution analysed.
• Key Stakeholders and pilot group identified
• Telephone Clinic set up and patient selection started
• Telephone Clinics started

 
Evaluation

• Donabedian’s (1966) Structure-Process-Outcome methodology utilised
• Patient satisfaction – evaluated via questionnaire
• Patient journey – analysis of physiotherapy capture, and discharge and re-attendance rates
• ‘Failure to contact’ rates analysed –compared to ‘did not attend’ rates for face-to-face consultations
• Consultant activity during the pilot period analysed.

 
Conclusion  
The introduction of the Telephone Follow-Up Clinic has made this service more responsive to patients’ needs whilst enhancing stakeholder engagement by offering alternative methods of contact. This intervention has had a positive impact on patient waiting times and Consultant activity.
 
Three key learning points  
1. Utilising alternative methods of patient contact ensures continuing patient participation in care
2. Communication and multidisciplinary team working are the cornerstones of excellent clinical practice
3. A robust support network is a necessity to facilitate successful navigation of the complexities of service provision

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