What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

It is estimated that one-third of the population is suffering with lower back pain at any point in time and that lower back pain is the primary cause of disability in the UK. It affects 84% of people in their lifetime (GIRFT, 2019).

The challenges within spinal services are well known, with increasing wait times. Subsequently overburdened Emergency Departments are managing more patients presenting with back pain leading to inappropriate admissions. Local data shows that once admitted average length of stay for these patients is 9 days.

Service users often unnecessarily move between primary and secondary care leading to inefficiencies across both local and regional systems and delays in management of the spinal condition. The aim of the project is to work collaboratively with the different stakeholders across the system to streamline the pathways through education and developing professional collaboration. This will subsequently reduce wait times, improve experience and outcomes for service users.

What does your project aim to achieve?

Significant work has been done to implement the GIRFT national specialty report for spinal services (2019). However, the pathways created do not always align with the needs of the service user and were established during a period of change and upheaval of COVID19. This has created silo working, repetition and reduced engagement across the systems.

Pilot work has already taken place looking at admission avoidance for back pain, this identified multiple referral pathways with no clearly defined process. This collaborative project led to further Emergency Department pilot work developing links with primary care and reducing inappropriate referrals.

Aims:

• Benchmark against back pain services
• Finish mapping the Leeds system back pain pathways
• Engagement of regional stakeholders to streamline back pain pathways within the West Yorkshire system based on benchmarking and mapping
• Implement education, training and communication processes across primary and secondary care to improve spinal pathways

How will the project be delivered?

Project will be year long with a project manager to facilitate communication and decision making and support implementation of improvements across systems.

This project will expand on recent PDSA cycles to improve the emergency department and medical admissions back pain pathways. This will also build on the newly established relationships with community partners  improving pathway flow and processes across the system.

With clear processes and pathways established for spinal patients in Leeds this will enable the project lead to share learning regionally and using national pathway guidance can support others to develop pathways and links to the tertiary spinal surgical services reducing inefficiencies, duplications and cost.

Measuring impact:

• patient feedback
• reducing inappropriate referrals & unnecessary hospital admissions
• reducing wait times for correct service

Risk: to patients being ‘lost’ in the system should reduce with this project due to clearer process/ pathways.

Relevant stakeholders: Service users, Therapy staff, Consultants, Service managers, GPs

How is your project going to share learning?

Ongoing development of relationships across the pathways with clear roles and responsibilities defined to maintain flow along the pathway

Use platforms such as the Q Community and Future NHS Collaboration to generate ideas and share learning.

Other services could have the same/ similar barriers therefore sharing this may generate ideas for improvement elsewhere.

Involving key stakeholders in the project, including patients, and sharing the results, will help promote the responsibility of key stakeholders in the patient pathway – i.e. referrer, treating clinician and patient (Triangle of equal responsibility).

The ideas and tests of change and learning from these could be shared and trialled in other services both regionally and nationally.

There will also be learning related to how to engage and involve patients in identifying areas for improvement and using this to reduce health inequalities within the service and beyond.