FOOT AND ANKLE SCREENING AND TRIAGE CLINIC AND BUNION SCHOOL: IMPROVING ACCESS TO CARE FOR PATIENTS WITH CHRONIC ORTHOPAEDIC FOOT AND ANKLE CONDITIONS

Patients with painful chronic foot and ankle conditions were facing wait times up to 5 years or longer to consult with a foot and ankle orthopaedic surgeon. The majority of patients require education in conservative treatment options rather than surgery. This program allows for improved access for patients requiring foot or ankle surgery, reduction in wait times for patient referral from GP to orthopaedic surgeon and ensures appropriate patients are referred for consult with the surgeon. It also allows for more detailed discussion with patients about their options and improved patient satisfaction. Based at three hospital sites in collaboration with the in-house foot and ankle surgeons, a specially trained physiotherapist performs a comprehensive 45-minute initial assessment of patients referred for specific chronic orthopaedic foot issues. Conservative and surgical options are reviewed as appropriate. If the patient is a potential candidate for surgery, they are placed in the queue for consultation with the surgeon. Given the high volume of referrals for patients with bunions, a targeted education session called “Bunion School” was developed and hosted at each site. The physiotherapist leads an hour-long education session for groups of patients referred for their bunions. If the patient wishes to pursue surgery, they are placed on the waitlist to consult with an orthopaedic surgeon. The program is funded by the provincial Ministry of Health. The FAST program and Bunion School improve the patient conversion rate to surgery for the orthopaedic surgeon from approximately 20% to 70–80%. Wait time to initial assessment pre-pandemic was 3 weeks and wait time to surgical consult was 3–6 months. Wait times have increased during the pandemic and currently are averaging 4–6 months to assessment and 6 months to surgical consult. Patient satisfaction rate for the initial assessment provided by the physiotherapist was 97%. Surgeon satisfaction was reported high, though not formally measured. The physiotherapist-led Foot and Ankle Screening and Triage Clinic and Bunion School have been successful regional initiatives, funded by the provincial Ministry of Health. These programs provide for timely patient education regarding their options prior to involving an orthopaedic surgeon. They enable patients to receive accurate information and allow for quicker access to care as well as cost-effectiveness within the health-care system. Surgical conversion rate was higher compared to patients seen directly by the surgeon without prior education. Patient and surgeon satisfaction were high.