Investments at Croom Orthopaedic Hospital cut waiting times

There has been an immediate increase in the number of interventions, which, over the past 18 months has grown from 18 per week to up to 50 patients every week.

Anna Marie Kiernan, candidate Advanced Nurse Practitioner in Pain Management, who has worked alongside Prof Harmon throughout this process, stressed that the improvements should not only be regarded in terms of numbers of patients seen, but in quality of service delivery.

“What has been achieved stems from our vision of the healthcare model, and a fresh focus on the processes that we had in place. At the time, our waiting lists from referral to review of 49 months, and approximately 60 weeks then for intervention, was an extremely long time for someone who is pain to wait for treatment,” Ms Kiernan said.

“What we identified was that it was key to put more work into the referral triage process in order to maximise the quality of referrals from GPs. This then leads to improvements in the quality of provisional diagnosis by our service. We worked closely with GPs in the region to better inform our multidisciplinary triage process. This closer relationship with GPs has enabled us to provide more rapid and accurate provisional diagnosis,” she explained.

Ms Kiernan continued: “By supporting GPs, we are also helping to educate and inform on the proper analgesic decisions for patients in the community.”

The complexity of the process stems from the peculiarities of diagnosing pain, which firstly is subjective, but also has underlying contributors.

“Pain is a symptom,” Ms Kiernan said. “By treating the symptom, you are putting a plaster on the symptom. Our focus is on identifying what the cause is, so that we can give an accurate diagnosis, address the underlying problem, and provide long term symptom management which will reduce the patient’s suffering. Diagnosis is key, and by doing the triage earlier, we can also refer to other specialist services based on the diagnosis. When you come to us, you’re not just waiting to see us in a clinic.

“Previously, we had to rely on GPs more to refer to other services based on our recommendations, but now they have more immediate access. We can provide, as part of our service, access to services that they previously might have had to pay for themselves, such as a psychology and physiotherapy,” Ms Kiernan said.

The future for the Pain Management Service involves ongoing amalgamation of services with the ultimate goal of empowerment of patients in the community, and reduction of the impact on specialist services, and on the Emergency Department where people often present with chronic pain issues.

“We are really only at the beginning of this journey. It is great that we are in a position to have so many services under one roof. We’re conscious of patients who are already disabled with pain having to repeatedly visit the hospital for different appointments. If we can help people all with one visit, it’s better for the patient, and better for the service,” she added.

Ms Kiernan concluded: “In our experience, patients love the new service, and the fact that everything is under one roof; that there are staff that they have a relationship with. That is also a key part of our overall vision, because trust is vital when it comes to treatment.”

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