BACK PAIN – A PROBLEM OF REFERRAL

Abstract

In the first half of 2000, the Auckland District Health Board was not effectively meeting the Government’s Elective Waiting Times. The Auckland Hospital Orthopaedic Department was initially targeted as it had one of the worst high profile examples given by the Ministry of Health of non-actively managed waiting list and FSA (First Specialist Assessment) process. In September of that year at Auckland Hospital 224 patients were waiting longer than six months to be seen and a number of spinal referrals were waiting up to two years.

An Elective Service Project Team was established to place proactive resources to meet the governments’ objectives. A prospective study enlisting all referred patients seen at the spinal clinic was undertaken to determine those patients who subsequently became surgical candidates. The nature of the GP referral in terms of accuracy of urgency, status of the patient at clinic, diagnosis, need for surgery, need for investigation, and finally the patients decision about surgical options were recorded. Concurrently a working party composed of spinal surgeon, clinic staff, hospital GP liaison staff, GP’s, and management was co-ordinated, to develop guidelines for the local GP’s, with the intention of allowing GP’s to better identify those patients who would benefit from referral. Subsequently we liased with the pain clinic to develop a treatment program for those patients who would not be seen by an orthopaedic surgeon, so that their individual problems would be addressed to their satisfaction, and that of the referring GP. A Primary Care Management Guide was also produced for the GP’s.

The FSA time has been significantly reduced. Patients have responded positively. We are now able to safely screen patients from referral letters to a back pain management programme and review those at the orthopaedic spinal clinics who are most likely to require surgery so as to maximise the utilisation of resources and to provide better care.