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  Performance, Impact and Effectiveness Review: Emergency Department Musculoskeletal Diversion Pathway (MSK Diversion Pathway)

  Lynton Norris, Beatrice Mendoza, Tim Leen, and Piers Truter

  PFS Consulting has been appointed to undertake a Performance, Impact and Effectiveness Review of the Emergency Department Musculoskeletal Diversion Outpatient Clinic Pathway (MSK Diversion Pathway). The aim of this project is to establish, measure and test the fundamentals of the MSK Diversion Pathway, in the following areas:

  1) Cost-effectiveness analysis – evaluation and outcomes data to: - Determine appropriate performance measures that can be derived from the available empirical data, assess the appropriate level of granularity against which to apply given the data limitations, and determine an appropriate Control Group (considering COVID impacts, clinical and actuarial suitability and technical validity of the analysis approaches) - Identify conditions and patient profile that is best suited to the MSK Diversion Pathway, reassess performance based on moving to a mainstream “operational/scalable” model of care (from a “research” focused phase/establishment)

  2) Financial sustainability, with a focus on proposed funding model and pilot/trial costs to: - Review current funding and program (including system) resourcing arrangements, interactions (limitations) of Activity Based Funding, and existing funding disincentives for MSK Diversion Pathway pilot - Determine the resourcing requirements and funding model, Compare and contrast with the existing ED pathway for identified patients, including current ED and Tier 2 funding (ABF), and consider interface with primary care (Medicare)

  3) Scalability of the MSK Diversion Pathway, considering the opportunity to increase MSK activity and throughput (as a direct result of the pilot) focusing on opportunities to scale, and hospital efficiency outcomes from the MSK Diversion Pathway."

  4) Potential as an innovative model of care under the National Health Reform Agreement (NHRA)

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  Urgent care for injuries: Consumer perspective from Rockingham community conversation – June 2024

  Piers Truter, Julie Walker, Judith Balfe, Beth Philipps, Gerard F. Hoyne, William Gibson, Matthew K. Bagg, Amanda Timler, Vinicius Cavalheri, and Caroline Bulsara

  Many people seeking urgent care have injuries (a new condition involving pain, sprain, strain or fracture of nerve, muscle, tendon, joint or bones). They make up 8-9% of the people going to the Rockingham General Hospital emergency department. In 2022, a new model of care started at the hospital diverting patients with injuries from the emergency department to physiotherapy outpatients. What happened: A community conversation was held in June 2024 in Rockingham to explore the issues associated with seeking urgent and follow up care with an injury. Consumers attended and their perspectives were workshopped with researchers from the University of Notre Dame Australia and the consumer engagement team from the WA Health Translation Network. What mattered to consumers:

  The key themes for consumers seeking urgent care with an injury in Rockingham are;

  1) Access to care: Out of office hours access to clinical and imaging services is a problem. Long waits in the emergency department are frustrating. Access to care needs to be consistent and high quality. Diverting patients from the emergency department was viewed positively.

  2) Communication: Clear communication from clinical staff is important. Urgent and follow up care services must share information and follow common processes. People expect reliable communication within and between Hospital and community services.

  3) Patient expectations: Acknowledging a person’s expectations of care and addressing their specific concerns was highly valued.

  4) Pathways of care: Consumers want easy flexible access to both urgent and follow up care. Urgent care should connect to a pathway of services to support recovery.

  5) Cost: Consumers do not expect to pay for urgent or follow up care. For some, this is a critical issue as they cannot afford to pay.

  6) Vulnerable people: Care seeking can be difficult for vulnerable people, who do not always feel listened to in health care encounters.

  7) Diverting patients from the emergency department: this model of care was strongly endorsed by consumers.

  Strongly endorsed consumer recommendations:

  1) Expand the diversion pathway to a community setting away from the hospital.

  2) Advertise the diversion pathway in the emergency department and in the community to allow consumers to make best use of this service.

  3) Combine all the hospital clinics into a ‘one-stop-shop’ for injuries. Have a clinic that provides urgent and follow up care and includes physiotherapists, orthopaedic doctors and nurse practitioners.

  4) Provide direct access the diversion pathway without having to go to the emergency department.