WHC now offering an Ultrasound Service

2 August 2022

Since March 2021 the Orthopaedic Interface Service (OIS) has provided an ultrasound service from Devizes Community Hospital. This includes ultrasound imaging and if appropriate ultrasound guided injection. Prior to this patients had to attend an acute hospital for ultrasound services. Being able to access an ultrasound service within the community provides the patient with greater choice in their care and convenience.

What is Ultrasound imaging and Ultrasound Guided Injection (USGI)?

Physiotherapists are increasingly using ultrasound imaging to diagnose and perform guided injections. The imaging can help the therapist with a diagnosis and the injections guided by ultrasound have shown to improve needle placement reducing the risk of impact on other tendons.

Physiotherapist being trained to perform an ultrasound scan on patientTraining

Brigitte Kingsley (pictured right with John Leddy and Robert Devine) has played a key role in establishing this new service within WHC.  Performing the scan is technically challenging with the training and ongoing supervision for this qualification takes around 2 years. Brigitte will become our first Advanced Physiotherapy Practitioner (APP) as an independent CASE accredited sonographer.

Benefits

In offering this service, Wiltshire Health and Care is able to:

  • Reduce patient waiting times and manage associated risks for an ultrasound investigation and/or ultrasound guided injection therapy in secondary care.
  • Reduce referrals to secondary care and avoid the associated cost for the specialist intervention (Ultrasound Guided Injection) and unnecessary orthopaedic referrals.
  • Improve the patient journey to reduce multi-practitioner contacts
  • Provide a diagnostic and therapeutic intervention which can be delivered as integrated part of the patient care plan and keep patient in primary care
  • Provide a diagnostic intervention in a primary care setting. Treating patients in their community at the right place at the right time.

Identifying patients:

Any patients referred to and assessed within Wiltshire Health and Care’s OIS are eligible to be referred for an ultrasound and guided injection if appropriate.  All patients within OIS are assessed against the inclusion/exclusion criteria to determine who would be a suitable candidate for:

  • Ultrasound diagnosis
  • Ultrasound guided injection
  • Dry needling, hydrodilatation, barbotage (these are other treatments offered)

The service has had an impressive start and within its first year has seen 86 patients within the community ultrasound service. There was great variability within the treatment being provided and the graph below shows the breakdown of body part treated.

Multicoloured pie chart to show range of pathologies seen within ultrasound clinic between March 2021 and March 2022. 38% hip, 38% shoulder, 11% knees, 8% hand/wrist and 5% feet/ankle

Patient Feedback

All ultrasound patients are asked to complete a Friends and Family feedback form.  After one month patients are asked to complete a MSK HQ form returned (this is a short questionnaire that enables patients with musculoskeletal conditions to report their symptoms and quality of life in a standardised way).  Ultrasound Injection patients are also requested to return an Injection Outcome feedback form to determine the impact of the injection.  In addition, a representative sample of patients were contacted at 6-months for an interview to ascertain more detailed feedback regarding their experience of the service.

Patient comments include:

‘Very good, really useful. Very happy with all work done, was given information on procedure step by step. Thank you’.

‘Prompt efficient consultation. Comprehensive explanation and condition fully explained. Plan agreed and way ahead identified.’

‘The staff were lovely and explained everything very well and very organised.’

Pie chart showing patient satisfaction following first consultation. 98% very good 2% good Multicoloured pir chart showing if patient required further practitioner contact. 51% did not. 16% went on to secondary care, 22% were seen by physio/podiatry, 7% went to their GP and 4% were seen by the OIS team

The feedback demonstrates the value and benefit of the new Ultrasound service.  WHC has been able to access Elective Recovery funding (this is additional funding allocated following the Covid pandemic to improve patient access to the right care) to enable this service to continue. The Orthopaedic Interface Service (OIS) is now running 2 Ultrasound clinics each month. Brigitte can see 12 patients per clinic with a lead wait time of just 4-8 weeks once patients have been signposted to the service. The ability to be able to assess/treat patients within such a short timeframe is a massive benefit to patients and it also helps to alleviate some of the pressure on the acute ultrasound services by seeing those patients within the community.