The Airedale Upper Limb Clinic

Background

At the height of the Covid-19 pandemic in early 2020, the orthopaedic department at Airedale NHS Foundation Trust was determined to find a solution to maximise the Trust’s resources and help reduce waiting and treatment times for patients suffering from shoulder pain.  

As part of their strategy, Airedale launched the first NHS ‘one-stop’ Upper Limb Clinic in October 2020. The clinic was spearheaded by Consultant Orthopaedic Surgeons James Tyler and David Bowe, alongside Consultant Radiologist Dr Amit Bharath and Advanced Physiotherapy Practitioner Stacey Lalande. The approach they adopted was game-changing.  For the first time, patients could be seen by a team of clinical specialists, including orthopaedic surgeons, consultant radiologists and specialist physiotherapists, in a single day. 

To support this new approach, they needed an effective means of triaging, assessing and monitoring their patients off-site, without the need to bring them into the hospital. With this in mind, Airedale approached Amplitude Clinical Outcomes to introduce an electronic PROMs system to support their process. 

The Approach

Amplitude worked in partnership with Airedale to implement a mini enterprise™ platform within the Upper Limb Unit. The mini enterprise™ solution allows smaller clinical teams to use the same platform, at a price that reflects the size of the team, making patient reported and clinically recorded data centrally available to all key stakeholders.

Patients report their symptoms via the mini enterprise™ patient portal before attending clinic, as well as recording their progress throughout their treatment period and beyond, from the comfort of their homes. Clinical staff at Airedale monitor patients remotely, enabling effective prioritisation of urgent cases and reducing unnecessary clinic appointments for patients who do not require further face-to-face intervention – ultimately optimising both clinical and administrative resources. 

Since its establishment, the ‘one-stop’ Upper Limb Clinic has branched into three ‘sub-centres’, which has allowed the Trust to adopt a more collaborative team approach, putting the patient at the centre, as they should be. 

1. The Acute Shoulder Centre – Patients who have been seen in A&E within the past seven days and have been given an urgent referral for treatment. 
2. The ‘One Stop’ Clinic – Patients who have a condition which can be treated in one appointment, such as bursitis, impingement or rotator cuff injuries and tennis/golfer’s elbow. The clinic allows patients to be diagnosed, receive an ultrasound, and start/complete their treatment (whether that be an injection or physiotherapy), in a single day. 
3. The Elective Surgery Centre – Patients who have more complex conditions and need to be seen by the orthopaedic team on several occasions; such as patients suffering from a frozen shoulder. Often these patients will require surgical intervention or ongoing physiotherapy. However, despite those patients needing to return for further appointments, they can still benefit from receiving physiotherapy or a guided injection during their first appointment; which they would not have had access to outside of the Upper Limb Clinic. 

The Results

The Amplitude mini enterprise™ platform has provided the Trust with a platform that ensures patients are assessed and treated correctly and efficiently from the outset. Patients do not need to go from one clinician to the other, returning to the hospital on multiple occasions. Their experience is of a cohesive unit that delivers joined-up care, efficiently.

The mini enterprise™ platform is enabling the Upper Limb Clinic to collect key data that is relevant and representative. By engaging with patients in the reporting of PROMs data and using that to evaluate severity and urgency, the Unit has also benefited from workflow efficiencies that have meant the patient experience, from appointments to care, is significantly improved. 

Additionally, the Upper Limb Unit is using real-time data available within the system, as part of their patient care plans, proactively reviewing and assessing PROMs scores within the clinical context of each patient, to support them in making more informed decisions and further streamlining the process of patient care. 

The results of this project have been ground breaking. The number of hospital-based appointments per patient has reduced from an average of 4 appointments to just 1. The average surgery waiting time is now around 4 weeks.  NHS staff and resources are being efficiently utilised, thereby optimising their effectiveness. Patients are benefiting from this efficiency not just in the quality of care but their overall experience is so much more positive, and patients who need urgent intervention and treatment are receiving this more quickly than ever before. 

Future Developments

The orthopaedic surgeons at Airedale NHS Foundation Trust are constantly striving to refine their processes and extend the quality of service they provide. Therefore, Amplitude continues to work with the Upper Limb Clinic to further develop its system usage. Current areas of development include: 

• Expanding use of the system

The Upper Limb Unit is increasing Consultant numbers to enable it to manage more patients. In addition, the model used by the Upper Limb Unit is being assessed for roll-out to other orthopaedic sub-specialty units. 

• Integration of the Amplitude platform with the Trust’s EPR system

Patient demographics would automatically be added to the Amplitude platform, thereby reducing the admin required to create patients on the system. 

• Patient language translations

Due to the multicultural nature of the UK, some patients attending the Upper Limb Clinic face communication challenges. Amplitude provides translation options to assist hospitals to engage more effectively with their non-English speaking patients.  This solution promotes inclusivity at the Clinic and ensures all patients have access to the same information, giving them a better understanding of the treatment. 

• Utilise Amplitude’s built-in reporting functionality

The Upper Limb Clinic has collected a substantial amount of rich patient and clinical data for both surgical and non-surgical procedures. Analysis of this data is key in identifying best practice and the efficiency of different treatment plans, supporting the Trust to make more informed decisions.