Date of Award
2024
Degree Name
Doctor of Philosophy (College of Health Sciences)
Schools and Centres
Health Sciences
First Supervisor
Associate Professor Dale Edgar
Second Supervisor
Professor Caroline Bulsara
Third Supervisor
Associate Professor Katrina Spilsbury
Fourth Supervisor
Clinical Associate Professor David Mountain
Abstract
Worldwide health care systems are under increasing pressure due to aging amongst ever growing populations with increasing co-morbidity and treatment options (WA DoH, 2019). Furthermore, how people choose to engage with health care and access and literacy for health information is also changing, as is understanding of the factors associated with good health outcomes. These changes are driving evolution in health care delivery. There is a need for high quality and sustainable models of care accompanied by judicious evaluation of impact in terms of health services deliverables and the consumer experience of care. This thesis explores the feasibility and applicability of alternative models of care for musculoskeletal conditions in the Western Australian (WA) public hospital system, particularly in the context of the primary community interface, which is the emergency department.
The first alternative model of care is the ‘Virtual Fracture Clinic’ (Mackenzie et al., 2018), also known as ‘the direct discharge model’ (Geerdink, Augustinus, et al., 2021). This model was first established in the National Health Service (NHS) in Scotland to reduce the burden on orthopaedic outpatient services and cost of care for people with minor self-limiting fractures (MSLF). The first focus of this thesis is therefore on MSLF management in the WA public hospital system and the adaptation of the virtual fracture clinic model into this jurisdiction.
Western Australian public hospital injury management pathways usually start in the emergency department (ED) and then connect patients to outpatient services for follow up. Evolution in one part of the pathway is inextricably linked to development in the whole pathway. The second model of care presented in this thesis is a physiotherapy-led ED Musculoskeletal Diversion Pathway, a health service innovation developed by the thesis author. This model of care can be applied broadly to all single system musculoskeletal conditions that bring people to the ED.
Accordingly, this thesis will present the results of studies that inform a new methodology to capture and describe current ED patient perspectives (Chapters 2 and 3), survey and describe current health service practices (Chapter 5) and evaluate the initial implementation of two alternative models of care for MSLF management in WA public hospitals, namely an Australian adaptation of a virtual fracture clinic (Chapter 6) and the ED Musculoskeletal Diversion Pathway (Chapter 8).
Publication Details
Truter, P. (2024). Optimising Care for Musculoskeletal Conditions to Reduce Burden on Hospital Emergency Department and Orthopaedic Services [Doctor of Philosophy (College of Health Sciences)]. The University of Notre Dame Australia. https://researchonline.nd.edu.au/theses/462