The ‘One-stop’ shoulder clinic – experience and outcomes

Authors: S.E. Gwilym, H. Mullett, S. Copeland, O. Levy

References: SECEC 2005

Abstract
AIMS: We report our experience of a one-stop shoulder clinic where diagnosis and treatment are expedited by specialist staff supported by on-site ultrasonography. We advocate the use of such clinics to provide an efficient system which reduces cost to both patient and institution.

MATERIAL: The clinic is staffed by a consultant shoulder surgeon, shoulder fellow, specialist physiotherapist and surgical trainee. Clinical decision making is facilitated by diagnostic injection and use of algorithm-based protocols. The economic impact of accelerated diagnosis and treatment in terms of the individual patient, healthcare spending and cost to industry is significant. We audited the number of patients seen in our service and correlated these to known costs for the provision of surgeon time, fixed ‘overhead’ costs and the cost of various imaging modalities. We also estimated the economic cost of multiple clinic attendances using national employment statistics.

RESULTS: Using the ‘one-stop’ approach enabled 1022 new patients to be seen in an annual period with an additional 2848 follow up patients reviewed by the team as a whole. By clinically evaluating a patient, utilising surgeon-operated ultrasound imaging and making management plans within a single visit we avoided return clinic visits and independent diagnostic imaging appointments. This equates to an average saving of £320 (467 euro) per patient. Return to work is generally reduced by a period of six-eight weeks which is equivalent to £2532-£3376 (3692-4923 euro) at the current average UK industrial wage.

CONCLUSION: The one-stop clinic shortens the cycle from diagnosis to treatment and follow-up. This not only has significant economic benefits but also greatly enhances the learning experience for trainees and facilities ongoing clinical audit and research.