With the ever-tightening squeeze of health care resources, many organisations (including mine) have established a number of Advanced Scope Clinics.
Just to clarify what I am referring to: Advanced Scope Clinics use Advanced Scope Practitioners to service the clinics. These practitioners are working within their currently recognised scope of practice for that profession, but that through custom and practice the clinics have previously been performed by other professions. An advanced scope role would require additional training, competency development, as well as significant clinical experience and formal peer recognition.
A few local examples include:
Orthopaedic Screening Clinic: Physiotherapists are the first contact practitioners for all Category 3 patients referred to Orthopaedics. (FYI – There are 3 categories, with Category 1 being most urgent). After the initial appointment, physiotherapists triage patients to either 1. appointment with a surgeon, 2. appointment with the surgeon, but trial conservative management while they are waiting, or 3. conservative management only, removed from the waitlist and never see an Orthopaedic Surgeon.
ENT Triage Clinic: Audiologists review all Category 2 and 3 patients that have ‘dizziness’ included in their presentation. Patients are removed from the waitlist if conservative management is deemed most appropriate.
Diabetes Clinic: A nurse practitioner is the first contact health professional and only refers to the Consultant on an ‘as needs’ basis.
Neurosurgery Allied Health Screening Clinic: A physiotherapy and psychology team are involved as first contact practitioners for all Category 2 and 3 patients referred to Neurosurgery. Onwards waitlist management as per the Orthopaedic Clinic.
Post-natal Gynaecology Clinics: All patients who experience a Grade 3-4 tear during childbirth are referred to a women’s health physiotherapy-led clinic 6-weeks after birth. Gynaecologists are not part of this clinic, but an onwards referral can be arranged as needed.
In summary, our research/auditing/QI activity in this space has been positive overall. Results show that these advanced scope/combined clinics seem to hit the ‘sweet spot’ of quality care, patient satisfaction, timely intervention, employee satisfaction and at a reduced cost……BUT there is always push-back when we suggest any such models of care to a department. I am hoping to learn from your collective wisdom.
My questions for comment:
- What examples of successful Advanced Scope Clinics within a tertiary setting do you have in your organisation?
- What has been your organisational enthusiasm for such clinics? What are the barriers? How have you overcome them?
- Do you have any examples of when things went ‘wrong’ that we can learn from?