Table 1 Current clinical practice
Action | Content | |
|---|---|---|
Before examination | Triage | The referral from the patient’s general practitioner is reviewed by an orthopaedic surgeon (OS) from The Shoulder Clinic. Depending on expected treatment plan, patients are allocated to one of three groups: 1) High probability of surgery or high complexity ➔ examination by an OS. 2) High probability of non-surgical treatment ➔ examination by an extended scope physiotherapist (ESP). 3) The remaining patients are distributed between ESPs or OSs based on first available time slot. |
Diagnostic imaging | X-ray of the glenohumeral and acromioclavicular joints are taken before examination of all patients. | |
Patient reported information | Patients are asked to fill in a questionnaire including demographics and use of medications | |
On day of examination | Duration of examination | Time frames for the examinations are 20 min for OS and 30–40 min for ESP. |
Physical framework | ESP and OS perform the examinations in adjacent rooms. | |
Diagnosis and treatment plan | The patient’s history is recorded based on ICF (International Classification of Functioning, Disability and Health). A clinical examination, including relevant diagnostic tests, is performed. In most cases an ultrasound imaging is also performed. Based on the findings, the patient is diagnosed. Based on a shared-decision process between the patient and the professional a treatment plan is decided on and initiated. | |
Communication | ESP and OS consult if questions arise regarding diagnosis or treatment plan. It is mandatory for the ESP to consult an OS, if the treatment plan includes surgery, steroid injection or referral to advanced diagnostic imaging. | |
Throughout the year | Coordination and meetings | Complex patient cases and diagnostic imaging results are discussed on a weekly conference between ESPs and OSs. When needed, patient cases are also discussed outside the scheduled conferences. Four times a year, the entire team at The Shoulder Clinic meets to update, evaluate and optimize clinical pathways for patients. |