‘Thresholds will cut unnecessary surgical referrals’

Hospital referral thresholds for a range of common hand and back procedures will cut the number of people referred unnecessarily for surgical treatment, the State’s health watchdog has said.

The Health Information and Quality Authority (Hiqa) said the successful implementation of the thresholds depended on timely access to primary care services for effective alternative treatments, such as physiotherapy.

The thresholds are to help ensure a more efficient use of available resources and speedier access for those in greatest need of treatment, while also reducing regional variation in clinical practice and access to procedures.

However, given that the need for surgery is exceeding existing capacity, it is unlikely the introduction of the thresholds will result in a decrease in the number of hospital procedures.

Hiqa director of health technology assessment, Dr Máirín Ryan, said that the thresholds could help identify those who stood to benefit most from surgery.

“This is a first step in a process that will require the combined efforts of a number of different parts of the health system to implement,” she said, adding that the thresholds would ultimately help to improve the efficiency, equity of access, and cost-effectiveness of the health services.

One report dealing with back pain said some patients were not being referred to physiotherapy before going down the hospital route because of limited access. It also referred to anecdotal reports that only 20% to 30% of those referred to consultant out-patient clinics were ultimately considered suitable candidates for surgery.

At the end of August there were 52,455 patients on the out-patient list for an orthopaedic appointment, with 45% waiting less than six months and 67% waiting less than 12 months. It pointed out that the HSE was in the process of standardising the management of out-patient services.

A protocol published by the HSE last January specified that patients should be treated on the basis of clinical urgency, with urgent referrals seen and treated.

According to the Hiqa report, a reduction in inappropriate referrals would reduce the demand for out- patient appointments and the use of standardised referral criteria would lead to the better prioritising of those referred for review.

“This should lead to those with a higher clinical need being seen and undergoing surgery earlier, with a potential reduction in waiting times for both outpatients appointments and surgery.”

It said the current annual national cost of lower back surgery is about €8.3m.