Advanced Practice Occupational Therapy (APOT) Led Integrated Hand and Wrist clinic.

Background/Need: This initiative is informed by the work completed over the last five years at St James’s Hospital (SJH) providing a “see and treat” waiting- list initiative for GP referred patients with hand and wrist pathology. Over 700+ patients attended the APOT – led hand and wrist clinic, with 60% discharged without requiring consultant referral. The outcomes of the last five years have highlighted the value of an APOT / hand therapist with the appropriate specialist skill level in reducing hospital waiting lists for hand and wrist pathology and improving access to care. An application was made to Spark Community Innovation Fund and was awarded to the Occupational therapy Department, SJH in February 2023 for 1 year to pilot this new initiative, between SJH and community networks 4,8 & 9. This is the first of its kind in Ireland delivering integrated scheduled patient care between hospital and primary care Occupational Therapists for GP referred patients with hand and wrist pathology.  This modernised care pathways provides patients with direct access to patient care in a primary care setting and is line with the HSE 2022 waiting list action plan, of providing an integrated referral pathway for all patients. The initiative aims to reduce unnecessary hospital attendances, whilst also reducing both hospital and consultant waiting lists and providing patients with more timely access to specialist APOT care in a primary care setting. Method/Process: The patient pathway was redesigned for a PC setting with direct referral from the GP to the APOT for patients with hand and wrist pathology including: Carpal Tunnel syndrome, Cubital tunnel, De Quervains, OA hand and wrist, 1st CMCJ OA, Lateral Epicondylitis, Trigger digit, Ganglion. Condition specific assessment forms and pathways for each condition were revised. Patient information leaflets for each condition were developed. An APOT led injection clinic at SJH was integrated into this service for trigger digit and De Quervains. The initiative also included competency based training of the PC senior OT to facilitate delivery of care alongside the APOT.   Results/Outcomes: 1 New (N=8) and 1 return (N=6) clinic per week. Number of GP referrals received to date: 277 Av: 6 new referrals per week. New Patients seen to date: N= 190 DNA’s = 4 CAN’s = 4 Time from referral received to appointment: 8 weeks. Patient outcomes to date: Discharged to surgeon N = 34 APOT injection clinic = 17 Discharged to GP= 54 Next Steps: Service evaluation of this new initiative is ongoing both from the perspective of the patient and the GP’s. Development and redesign of patient information to a digital format and access to a health- link referral process is currently being explored. This service initiative has the potential to scale up and spread to other acute hospital and primary care settings within Ireland. Opportunities to secure funding for the continuation of this service and the expansion to new sites is also currently being explored.