Advanced Scope Clinics
Advanced scope clinics: Do they hit the 'sweet spot' of quality care, patient satisfaction, timely intervention, employee satisfaction and at a reduced cost??
With the ever-tightening squeeze of health care resources, many organisations (including mine) have established a number of Advanced Scope Clinics.
Just to clarify what I am referring to: Advanced Scope Clinics use Advanced Scope Practitioners to service the clinics. These practitioners are working within their currently recognised scope of practice for that profession, but that through custom and practice the clinics have previously been performed by other professions. An advanced scope role would require additional training, competency development, as well as significant clinical experience and formal peer recognition.
A few local examples include:
Orthopaedic Screening Clinic: Physiotherapists are the first contact practitioners for all Category 3 patients referred to Orthopaedics. (FYI – There are 3 categories, with Category 1 being most urgent). After the initial appointment, physiotherapists triage patients to either 1. appointment with a surgeon, 2. appointment with the surgeon, but trial conservative management while they are waiting, or 3. conservative management only, removed from the waitlist and never see an Orthopaedic Surgeon.
ENT Triage Clinic: Audiologists review all Category 2 and 3 patients that have ‘dizziness’ included in their presentation. Patients are removed from the waitlist if conservative management is deemed most appropriate.
Diabetes Clinic: A nurse practitioner is the first contact health professional and only refers to the Consultant on an ‘as needs’ basis.
Neurosurgery Allied Health Screening Clinic: A physiotherapy and psychology team are involved as first contact practitioners for all Category 2 and 3 patients referred to Neurosurgery. Onwards waitlist management as per the Orthopaedic Clinic.
Post-natal Gynaecology Clinics: All patients who experience a Grade 3-4 tear during childbirth are referred to a women’s health physiotherapy-led clinic 6-weeks after birth. Gynaecologists are not part of this clinic, but an onwards referral can be arranged as needed.
In summary, our research/auditing/QI activity in this space has been positive overall. Results show that these advanced scope/combined clinics seem to hit the ‘sweet spot’ of quality care, patient satisfaction, timely intervention, employee satisfaction and at a reduced cost……BUT there is always push-back when we suggest any such models of care to a department. I am hoping to learn from your collective wisdom.
My questions for comment:
- What examples of successful Advanced Scope Clinics within a tertiary setting do you have in your organisation?
- What has been your organisational enthusiasm for such clinics? What are the barriers? How have you overcome them?
- Do you have any examples of when things went ‘wrong’ that we can learn from?
Participant comments on Advanced Scope Clinics
Advance practice practitioners have been in primary care and outpatient settings with great success. We have experienced decrease wait times, reduced cost of care and outcomes have been either equal or better.
Challenges have been poor role clarification and admitting patients to the hospital
Most of our challenges have been with physician assistants because they are not licensed to practice independently. We however have overcome this by using more Nurse practitioners in the outpatient settings because they can practice independently. We have used PA’s more in the inpatient setting where they will have more direct oversight by a physician.
Admitting patients to the hospital no longer has been a challenge now that we use a hospitalist group that will directly admit patients when needed.
We also utilize our pharmacists to monitor and dose in the anticoagulation clinic and do medication reconciliation
In our cardiology clinic Advance practice practitioners see patients first and depending on illness severity are then seen by the cardiologist
Thank you East Coast Connection 🙂
Can I clarify what a Physician’s Assistant is? Are they not medical practitioners? What training do PA’s have?
A physician Assistant is a professional who practices medicine in collaboration or under indirect supervision of a physician. They are widely used in the US and undergo specialized training. The program is similar to a nurse practitioner but they are not Licensed to practice independently like NP’s.