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Clinical Programme Update

November 2019​


Trauma and Orthopaedics is a high volume, high-risk specialty in terms of both waiting times and service delivery, crossing both planned (scheduled) and trauma (unscheduled) care and is a ‘tracer’ specialty for most mixed specialty hospitals.

The Programme acts as an advisory body for acute hospitals and the DOH across a range of issues, Metal on Metal implants, Taskforce for staffing and skill mix, development of Operating Department Assistant role, Bypass protocols. The programme regularly supports hospital management/hospital group management/consultants in trauma and orthopaedic hospitals.

Principles of the National Clinical Programme for Trauma and Orthopaedic Surgery:

- Increase the safety and accessibility of trauma and orthopaedic care to patients through robust, streamlined care implemented consistently across the service.
- Equity of access for patients to unscheduled and scheduled care.
- Development Networks /Hub & Spoke Model for Scheduled Care similar to the Trauma System Model.
- Improvements in waiting times delivered through an effective partnership between Primary and Secondary Care, with appropriate protocols and documentation in place for referral and discharge.
- Care delivered at the lowest appropriate level of complexity through comprehensive care pathways that patients can easily access and service providers can deliver, which is a principle of Sláintecare.
- Audit Governance – Irish National Joint Register and Irish Hip Fracture Database
Trauma and Orthopaedics has led on change in healthcare delivery.

Best Practice Tariff
A major achievement for the programme was the agreement by the Healthcare Pricing Office in collaboration with Dr Colm Henry and the NCP TOS to pay a Best Practice Tariff for Hip (BPT) Fracture patients. To qualify for the BPT all the Irish Hip Fracture Standards must be met. This tariff has incentivised improved quality care for a vulnerable group of patients

The Irish Institute of Trauma and Orthopaedic Surgery is the Clinical Advisory Group for the programme. Two new groups will be established in January 2020, a Health and Social Care Group and a Nursing Group. Both of these will be available as a resource for the programme in their specialist areas. This will be particularly important for updating the model of care.

Trauma Assessment Clinics
Trauma Assessment Clinics (TAC) model is a proven method of ensuring that only patients who require follow-up at fracture clinics would receive such appointments (National Model of Care for Trauma and Orthopaedic Surgery 2015). Studies from centres with established virtual fracture clinics reveal a safe and robust patient pathway with good functional outcomes and patient satisfaction. TAC clinics are consultant delivered with multidisciplinary input. The Programme is delighted that the awarding of a Sláintecare grant of €200,000 has recognised the success of TAC. We continue to lobby for the additional funding required to rollout TAC nationally.

Musculoskeletal Physiotherapy Triage Programme:
Continues to perform exceptionally well, an Interface Model has been developed and the Programme is currently seeking funding to launch this.
Mr Brian Lenehan has already commenced a pilot of the Interface Model in North Clare and we commend his initiative.
The vacant MSK Performance and Planning Lead post (PPL) will be advertised in January, the former MSK lead Aisling Brennan has returned to clinical work. We would like to acknowledge the great work that Aisling has done in developing this role. We have secured an agreement with the MSK Steering Group that the PPL post will transfer to RCSI from January

Delivered Benefit:
MSK Triage Initiative led to a 130,000 reduction in Orthopaedic and Rheumatology waiting lists (combined), 80% of these are orthopaedic.
Planned Benefit: Interface Clinics will remove an estimated 7,800 MSK patients (or more) from the acute setting over the 3-year period.
Planned benefit: Interface clinics, if adopted nationally post pilot, will remove an estimated 65% of MSK patients from the acute setting.
Planned Benefit: Patient experience improved as Interface Clinics triage patients in a far more efficient and effective manner.

Fracture Liaison Services:
The programme established a National Fracture Liaison Development Group Committee in 2018. The purpose of this multidisciplinary steering group is to develop and implement a national programme to improve patient outcomes after a fragility fracture through compliance with national and international standards. The group’s focus is on implementing recommendation 15 of a Trauma System for Ireland: Report of the Trauma Steering Group (2018) – The HSE should develop a comprehensive Fracture Liaison Service to provide high quality, evidence-based care to those who suffer a fragility fracture with a focus on achieving the best outcomes for recovery, rehabilitation and secondary prevention of further fracture.
The group meet regularly and are currently scoping out the establishment of a FLS Database pilot. Pharma funding has been secured for the pilot.

Trauma Review Implementation Group (TRIG)
The NCP TOS continues to drive and support the implementation of the national trauma system. Collaborate and advise the National Clinical Lead for Trauma Services, in developing trauma network protocols for major trauma patients. Provide advice and support to the candidate major trauma centres and trauma units on best practice in delivering trauma and orthopaedic care. Continued focus on driving expansion of bypass protocol implementation
Back Pain Pathway. This is the first in a suite of standardised referral guidelines, to be developed, with the aim of establishing best practice GP electronic referral guidelines to improve primary care assessment and treatment and reduce referral patterns from GPs to secondary care.

The programme continues to provide governance and support to the Irish Hip Fracture Database, The Irish National Orthopaedic Register, The Major Trauma Audit and scoping out the development of a National Spine Audit.

We continue to have close collaboration with a range of senior decision makers in the HSE and the DOH, including, the National Clinical Advisors and Group Lead for Acute Hospitals and Primary Care, the Chief Clinical Officer, Deputy Director General for Strategy HSE, National Treatment Purchase Fund and the Chief Clinical Information Officer. We also liaise with other Clinical Programmes, HSE Strategy and Acute Divisions.

Irish College of General Practitioners (ICGP)
To date we have had limited engagement with GP’s, it has been challenging to progress any of our integrated projects through the HSE Primary Care route. Early this month we held a meeting with Dr Tony Cox the Medical Director of the ICGP. This was a very productive meeting; we now have a communication channel with the ICGP and its various subgroups. Dr Cox expressed a particular interest in the development of an injection therapy course for GP’s. We have requested an opportunity to present to the ICGP Council on the wider musculoskeletal agenda.

Special Thanks / Mention

The Programme leads would like to thank the following:

The clinical advisors, Marcus Timlin and Eoin Sheehan

The regional leads, Brian Lenehan, Eoin Sheehan, May Cleary, Alan Walsh, Seamus Morris, Bill Gaine, and Paula Kelly.

The Health Social Care and Professional (HSCP) lead for the Programme - Edel Callanan.

We also wish to acknowledge the cooperation and collaboration of our colleagues nationally, this is very important, as the programme is here to support and assist you all.

We would also like to congratulate Keith Synnott in his new role as National Clinical lead for Trauma. The appointment of a national clinical lead for trauma is a milestone day for the speciality and in particular for trauma patients.

David Moore                     Paddy Kenny

Joint Clinical Lead            Joint Clinical Lead