These costs were minimal and met by the radiology and MCAS teams.įollowing the introduction of the pilot study a re-audit was undertaken to monitor any changes that occurred as a result of the introduction of the modified pathway. The project incurred cost for the production of the posters (made in house and printed by project leads) and posting information to local GP’s.
The pilot study was introduced on the 1st June 2015 for a 3 month period. This section of the pathway is still currently being reviewed. Urgent access to the MCAS service was offered to GP’s for patients they had concerns about. It was also highlighted to the GP’s that x-rays requested for serious pathology are negatively reassuring as they often do not pick up sinister pathology until it is advanced. Re-assurances were given by Radiology and MCAS that this pathway was for those presenting with non-specific low back pain. The main problem that we faced was that numerous GP’s were concerned that serious pathology would be missed. Posters were produced to display in GP waiting rooms, physiotherapy and radiology departments to educate patients as to the reasoning not to x-ray the lumbar spine for non-specific low back pain. A representative from the MCAS team (Jane Griffiths) and the Radiology Department (Dr Dawn Howes) presented the pilot study to the local PT4l (GP meeting), the Physiotherapy MCAS and Radiology departments to inform staff of the pilot study. A letter was formulated by the group and sent to all the GPs in the locality informing them of the pilot study with a copy of pathway for the management of mechanical low back pain. If more advanced assessment and imaging was required the patients were directed to the Musculoskeletal Assessment Service (MCAS) from Physiotherapy. The group looked at the spinal pathway that was in place and made some modifications ensuring that those patients with non-specific low back pain were directed to the Physiotherapy Walk in service in the first instance rather than for imaging.Īny requests for x-rays made by GP’s were rejected and the radiology department sign posted the referrals directly to Physiotherapy for assessment and management. The Radiology department in conjunction the MCAS team (Musculoskeletal Assessment Service) met with the Director of primary care and a lead GP for the Local Advisory committee to discuss the proposed pilot study.Īgreement was sought for change and for the pilot study to proceed. In order to put the NICE guidance into practice the following steps were undertaken: Avoiding exposing them to harmful unnecessary radiation at a cost to the Health board that did not change their management.
#SPINE NUMBERS PROFESSIONAL#
The audit highlighted that a change in the spinal pathway was required in - order to ensure that patients with non-specific low back pain were seen by the most appropriate professional in a timely manner. The audit highlighted that patients were being exposed too unnecessary radiation and timing delays for appropriate management at an estimated financial cost to the Health board of £55,546. The average age of the patients who underwent the x-rays was 52.1. The audit found that 73% of X-rays undertaken were inappropriate. The specific relevant recommendations in the updated guideline NG59 are recommendation 1.1.4 "Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica".Ī total of 100 consecutive non trauma lumbar x-ray requests from Primary Care GPs were audited for a 3 month period. An audit carried out in the Radiology department at the Princess of Wales Hospital highlighted inappropriate lumbar spine X-rays being undertaken for non-specific low back pain against recommendations of NICE guidelines (Low back pain in over 16's).
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