A physiotherapy led Soft Tissue Injury Clinic is an efficient and cost effective model of care. A paediatric specific interrupted time series study

Natasha Smith; Kellie Stockton; Liam Johnson; Steven M McPhail

doi:10.1016/j.physio.2022.01.006

A physiotherapy led Soft Tissue Injury Clinic is an efficient and cost effective model of care. A paediatric specific interrupted time series study

Physiotherapy. 2022 Sep:116:72-78. doi: 10.1016/j.physio.2022.01.006. Epub 2022 Feb 13.

Authors

Natasha Smith¹, Kellie Stockton², Liam Johnson³, Steven M McPhail⁴

Affiliations

¹ Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland, 501 Stanley St, South Brisbane, QLD, 4101, Australia. Electronic address: natasha.weaver@my.jcu.edu.au.
² Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland, 501 Stanley St, South Brisbane, QLD, 4101, Australia; Bond Institute of Health & Sport, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia. Electronic address: kellie.stockton@health.qld.gov.au.
³ Orthopaedic Department, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia. Electronic address: Liam.johnson@health.qld.gov.au.
⁴ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia; Digital Health and Informatics Directorate, Metro South Health, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. Electronic address: steven.mcPhail@qut.edu.au.

PMID: 35550489
DOI: 10.1016/j.physio.2022.01.006

Abstract

Objectives: To evaluate the effect of introducing a physiotherapist-led paediatric Soft Tissue Injury Clinic model as an alternative to a medically led Fracture Clinic model for conservative hospital management of soft-tissue injuries on: patient wait times; healthcare resource use; and cost-effectiveness.

Design: Interrupted time-series analysis (including consecutive eligible-cases).

Setting: Children's hospital, Australia.

Participants: The study included 245 cases (117 Soft Tissue Injury Clinic model sample, 128 Fracture Clinic model sample) of patients (<18 years) who presented to a specialist children's hospital emergency department and diagnosed with a soft tissue injury requiring non-surgical outpatient management.

Interventions: Patients were referred from the emergency department to either an orthopaedic-led fracture clinic (Fracture Clinic model) or physiotherapist-led clinic (Soft Tissue Injury Clinic model) for follow-up and further management as clinically indicated.

Main outcome measures: Time from emergency department discharge to commencement of definitive outpatient management (primary); healthcare resource use and costs from hospital funder perspective (secondary) and cost-per-day less waiting (cost-effectiveness).

Results: The Soft Tissue Injury Clinic was associated with (mean per-person difference (95%CI), P-value) fewer wait days (-8 (-11, -5) days, P<0.001), fewer orthopaedic costs P<0.001, >99% probability of fewer days waiting, 81% probability of less total cost and 81% probability of dominance (cheaper and fewer days to access definitive care). There were no adverse events in either model.

Conclusions: The physiotherapist-led Soft Tissue Injury Clinic represented a safe and efficient alternative referral pathway for patients presenting to the emergency department with soft tissue injuries requiring conservative management.

Keywords: Costeffectiveness; Economic evaluation; Orthopaedics; Physiotherapy; Soft tissue injury.

MeSH terms

Ambulatory Care Facilities
Child
Cost-Benefit Analysis
Humans
Interrupted Time Series Analysis
Physical Therapy Modalities*
Soft Tissue Injuries* / therapy