AUDIT OF A REVISED PATHWAY AIMED AT EXPEDITING DIAGNOSIS AND TREATMENT FOR SUSPECTED ACHILLES TENDON RUPTURE AT A SINGLE NATIONAL HEALTH SERVICE TRUST
Aliabbas Moosa, Kirsty Cole, Mahmoud Elmesalmi, Rawad Azaz, Henry Rowe, Amanda Rhodes, Toguy Koç
Queen Alexandra Hospital
The Achilles tendon is the most frequently ruptured tendon. Treatment outcomes depend upon prompt diagnosis and management. A local study in 2018 highlighted inefficiencies in the patient pathway. Key areas were identified for service redesign and improvement. This study aimed to evaluate the impact of a revised, novel pathway on the timescales from presentation to ultrasound diagnosis and definitive treatment decision.
All suspected Achilles tendon ruptures from April 2021 to March 2022 were retrospectively reviewed through electronic records. Information regarding the period from presentation to diagnosis and subsequent treatment decision was collected. Timescales were compared to those in the 2018 study. Performance was also assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol.
In total 87 patients were identified, of whom all received an ultrasound examination. Departmental standards were met in most cases; 93% (n=81) diagnosed within one week of presentation and 96.5% (n=84) given a treatment decision within two weeks. In the 2018 study, these figures were 78% and 83% respectively.
When compared with timeframes developed for the SMART protocol, 34% (n=30) were scanned within 48 hours of presentation. Compared to the 2018 study, this is an improvement but remains below target.
Since the Introduction of the new pathway, there has been a significant improvement in the number of patients diagnosed within one week and offered a treatment decision within two weeks (p<0.05). This completed audit cycle demonstrates an effective pathway to expedite diagnosis and treatment for Achilles tendon ruptures.