COVID-19: MSK service guide

April 2020

Scope

This information provides guidance on the management of MSK patients across Torbay and South Devon during the Covid-19 pandemic. The information is based on National Guidance.

National guidance

This guidance is to help primary or community care practitioners recognise serious pathology which requires emergency or urgent referral to secondary care in patients who present with new or worsening musculoskeletal (MSK) symptoms. Serious pathology as a cause of MSK conditions is considered rare, but it needs to be managed either as an emergency or as urgent onward referral as directed by local pathways.

Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral

​2WW referrals

2WW referrals should continue as normal.

Red Flags

2WW referrals should continue as normal.

Red flag spinal referrals can be referred for urgent physio triage on 0300 4569987

Spinal Pathway Red Flag patients

There is limited access to Nerve root blocks from Wednesday (very limited capacity) we still have no access to lidocaine infusions for cervical radiculopathies. We have opened the spinal clinics next week to video and telephone consultations and allow the physio's to refer routine spinal patients. The advice regarding CES and red flags that I outlined below remains a constant for the GP's in terms of there consideration/actions for these types of patients.

CES as an emergency pathology means direct referral by the GP to A&E. I have attached the spinal pathway and below are the red flag exclusion criteria.

Exclusions/ "Red flag" patients:

  • Exclusions to this pathway apply and these patients should receive urgent referral to secondary care, bypassingcommunity assessment:
  • Suspected Cauda Equina Syndrome (see pathway)
  • History of cancer/ patient is under oncology – possible spinal metastasis.
  • Under 16 year olds.
  • Patients with recent trauma should be referred to the Emergency Department e.g. suspected osteoporotic fracture
  • Use SAICO / phone the Spinal Clinic for advice if necessary
  • Use SAICO Rheumatology and Pain Clinic for advice if necessary.
  • Use SAICO for MSK Radiology team radiology.sdhct@nhs.net if necessary

Please see the process flowchart for the full pathway

Urgent Conditions

2WW referrals should continue as normal.

Red flag spinal referrals can be referred for urgent physio triage on 0300 4569987

Urgent advice

Please see advice and guidance contact details for any urgent MSK queries:

To be used for any urgent opinions for advice and guidance. Regarding acute Orthopaedic injuries can we please ask that any injury where the community MIU's are considering application of splint/plaster or onward referral to the fracture clinic be discussed acutely via the Consultant orthopaedic surgeon timetabled to be in ED; please ask Torbay Hospital Switchboard for contact details.

For urgent GP referrals or advice, please contact the On Call Orthopaedic Consultant via Torbay Hospital Switchboard Telephone: 0300 456 8000 (local rate) or 01803 614567

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Advice and guidance contact details for any urgent MSK queries:

For urgent GP referrals or advice

Please contact the On Call Orthopaedic Consultant via Torbay Hospital Switchboard, Telephone: 0300 456 8000 (local rate) or 01803 614567

Red flag spinal referrals can be referred for urgent physio triage on 0300 4569987

Supporting Information

GP Information

Spinal Pathway Red Flag patients

There is limited access to Nerve root blocks from Wednesday (very limited capacity) we still have no access to lidocaine infusions for cervical radiculopathies. We have opened the spinal clinics next week to video and telephone consultations and allow the physio's to refer routine spinal patients. The advice regarding CES and red flags that I outlined below remains a constant for the GP's in terms of there consideration/actions for these types of patients.

CES as an emergency pathology means direct referral by the GP to A&E. I have attached the spinal pathway and below are the red flag exclusion criteria.

Exclusions/ "Red flag" patients:

  • Exclusions to this pathway apply and these patients should receive urgent referral to secondary care, bypassingcommunity assessment:
  • Suspected Cauda Equina Syndrome (see pathway)
  • History of cancer/ patient is under oncology – possible spinal metastasis.
  • Under 16 year olds.
  • Patients with recent trauma should be referred to the Emergency Department e.g. suspected osteoporotic fracture
  • Use SAICO / phone the Spinal Clinic for advice if necessary
  • Use SAICO Rheumatology and Pain Clinic for advice if necessary.
  • Use SAICO for MSK Radiology team radiology.sdhct@nhs.net if necessary

Please see the process flowchart for the full pathway

For Physio

SDFT outpatient services

All MSK clinics are now up and running with initial appointments via phone consult. patients are booked by physio following phone/video consult. Pathway has changed, patient emailed self-directed resource list once appointment booked. All patients receive a phone consult. Patients are offered a choice of follow ups via face 2 face or phone if required all booked by physio. Patients should continue to self-refer.

Specialist clinics - hip/knee patients on pending lists being triaged and clinics for new patients operating via video link only. All follow up patients suitable for video consult have been contacted and progressed.

  • Spinal - red flag screening continues patients being managed via phone/video consult. Pathway not fully operational as no NRBs currently on offer can refer as far as MRI only.
  • Upper limb - hand therapy urgent patient seen face to face/phone. other upper limb triaged for physio (not ortho) managed phone/video consult.
  • Womens health - patients triaged and managed via phone/video consult.
  • Pain - use of video consults, reconnect 2 life website and workshops on vimeo platform - do you need the link??
  • Vestibular plan to triage and contact patients within the next 3 weeks.
  • Rheumatology - urgent patients managed via video consults.

Resources

  • We are continuing to use our video and patient information resources to assist patients.
  • Hip and Knee videos are due to be uploaded to our site next week.
  • Developed a pre-appointment information sheet emailed to patients - current wait is 10 days.
  • Reconnect2life

There are online physiotherapy resources for self-management available here.

National Guidance

Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral

Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic

Patient information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 28-09-2020

 

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