ICAT PRESENTATION

ICATS for Orthopaedics : 

ICATS for Orthopaedics ESP and GP/SI led clinics for Knee and Shoulder problems

WHY? : 

WHY? Why do we need yet another service between GP and consultant?

National Audit Data shows: : 

National Audit Data shows: 30-40% of GP Orthopaedic referrals don’t need surgery In some areas this figure is 60% Locally Orthopaedic referrals have increased more than any other specialty Local conversion rates are between 30-60%

The bottom Line : 

The bottom Line Money is an Issue, especially in these times. Many cases are referred for an opinion rather than an operation- GP’s do not have time or resources to do full MSK work ups. ICATS can do this in a community setting in a time efficient manner.

DOES THE ICAT MODEL WORK? : 

DOES THE ICAT MODEL WORK? Yes Orthopaedic Choice in Southampton 2001-current Financial savings by reducing OPD appointments Financial savings by directing patients into the right service Integration of Primary and Secondary care

ORTHOPAEDIC CHOICE OUTCOMES : 

ORTHOPAEDIC CHOICE OUTCOMES 52% referred back to GP after 1st appointment 27% referred to community therapy 20% referred to secondary care 85% conversion rate to surgery Now involves 13 sites and 26 clinics Lower limb, upper limb, hand and Back teams Also Rheumatology and Pain

Audit Data : 

Audit Data 262 knee and shoulder referrals were audited over a three month period. 50% of the referrals were deemed as possibly being suitable for the ICATs clinic Quality of Knee referrals was also audited: 54% of knee referrals had adequate historical information (duration, hx trauma, hx swelling) 40% of knee referrals had no XR or Physio prior to referral (Traumatic and Atraumatic pain)

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Audit Data for Atraumatic knee pain

How does it work? : 

How does it work? All knee and shoulder referrals get sifted by a member of MSK team Sifting is based on the same referral criteria you have been sent- copies here Patients are seen at Mount Gould by an ESP or a GP/SI XR on-site, MRI within 2 weeks, U/S within 3-4 weeks.

Who are we? : 

Who are we? ESP Physiotherapists are Rachel Andrews- Knee Andrew Rich – Shoulder GP/SI’s are: John Fotheringham Paul Giles

Knee Criteria-refer ICAT : 

Knee Criteria-refer ICAT Traumatic with- Persistent pain swelling or instability>6-8 wks Uncertain diagnosis requiring Ix Atraumatic with- Ant knee pain>8wks not responding with conservative treatment (rest, NSAIDs, PT etc) All other soft tissue knee problems not resolving with conservative rx Persistent knee problems without a diagnosis (<65 yrs)

Knee Criteria refer Ortho : 

Knee Criteria refer Ortho Traumatic with- Fracture-old, new, suspected clinically Acute Haemarthrosis/high speed twisting injury with immediate swelling – Acute Clinic Pos MRI findings if done by GP Asymmetric laxity on varus/valgus Atraumatic with Loose bodies/OCD on XR/MRI with symptoms

Knee Criteria Cont : 

Knee Criteria Cont 2) OA confirmed on XR in pt suitable for TKR 3) Persistent knee pain>65 who has not responded to conservative treatment. Other- Review cases Complex cases Under 16’s

What we want from you : 

What we want from you Adequate historical information as per criteria If degeneration/OA suspected please do XR and INCLUDE report in referral If Physio has been tried include report or site and name of therapist If you don’t want a patient to be seen by ICATs please say.

LOCAL OUTCOMES –KNEE : 

LOCAL OUTCOMES –KNEE DATA SEP-JAN 36% Discharged after 1st appointment 15% referred onto secondary care 34% referred for investigation 15% follow up/other

LOCAL OUTCOMES-SHOULDER : 

LOCAL OUTCOMES-SHOULDER DATA SEP-JAN 37% discharged after first appointment 4% referred onto secondary care 38% referred for investigation (U/S, U/S guided inj or MRI) Balance is Follow up (e.g. see after inj/rest)

Working towards : 

Foot and Ankle service to start June Direct listing from ICATs Wish List Specialist clinics in the community Community based U/S and U/S guided injection. One stop shop clinic Working towards

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QUESTIONS ?