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Toronto Western Hospital study demonstrates improved wait times for patients suffering back pain

Results of a Toronto Western Hospital study show that patients suffering back pain get quicker diagnosis and treatment when a Nurse Practitioner conducts the first examination. Traditionally, patients face long and anxiety-ridden wait times - up to 52 weeks before an initial examination by a spine surgeon. Results from the year long TWH study showed wait times for patients examined by a Nurse Practitioner were significantly shorter, ranging from 10 to 21 weeks.

"Waiting times for specialty consultations in public healthcare systems worldwide are lengthy and impose undue stress on patients waiting for further information and management of their condition" says study author and Nurse Practitioner Ms. Angela Sarro. "Back pain can be very unpleasant and debilitating and 85 per cent of us will experience it at some point in our lives.

The impetus for this year long study conducted was the fact that in about 90% of cases, patients are not surgical candidates. Their treatment plan usually consists of education, and non-invasive therapies to help manage their conditions. So TWH designed the study to determine patient satisfaction when a Nurse Practitioner conducts the first examination.

Ninety-six per cent of patients said they were satisfied with the care and treatment plan given by the Nurse Practitioner. The study, entitled "Nurse practitioner-led surgical spine consultation clinic", is published in the December 2010 issue of the Journal of Advanced Nursing. The study was conducted in 2008.

The study also showed the Nurse Practitioner came up with the same clinical diagnosis as orthopaedic spine surgeons Dr Yoga Raja Rampersaud and Dr Stephen Lewis in 100 per cent of the 177 patients assessed. Dr.'s Rampersaud and Lewis are co-authors of the study.

The 96 male and 81 female patients ranged from 23 to 85 years of age, with an average age of 52. All had been referred by their family doctor with suspected disc-herniation, spinal stenosis or degenerative disc disease.

Key findings included:

Patients waited ten to 21 weeks to see the nurse practitioner, with an average wait of 12 weeks. This compared with ten to 52 weeks to be seen by the surgeons in a conventional clinic, with average waiting times ranging from three to four months for disc herniations to eight to twelve months for spinal stenosis.

Just under ten per cent (18 patients) were correctly identified as surgical candidates by the nurse practitioner. In addition, 66 were referred for specific nerve root block, 14 for facet block and 26 for further radiological imaging.

"Nurse practitioners have received additional specialist training" explains Ms. Sarro. "They typically work in healthcare centres and primary care practices in the community, but their role is advancing into areas such as emergency departments and long-term care settings.

"At the moment there are clinical, legal and funding barriers in the Canadian health system that prevent nurse practitioners from being fully independent when it comes to assessing and managing patients who require specialist care. However, we feel that there may be scope for government-funded triage clinics led by nurse practitioners to reduce waiting times for spine consultations.", says Ms. Sarro.

Co-author Dr Yoga Raja Rampersaud adds, "We believe that our study demonstrates that nurse practitioners can play an effective and efficient role in delivering timely healthcare to patients requiring specific disease management in a specialty setting.

Toronto Western Hospital is now assessing the potential to expand the practice of Nurse Practitioners being the point of contact for ongoing care of patients with a variety of conditions.


Contact: Christian Cote
University Health Network

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