When a patient is unable to access healthcare services in their local area, they may choose to travel to receive appropriate treatment, resulting in travel-related carbon emissions.
Northern Sydney Local Health District (NSLHD), in partnership with Central Coast Local Health District (CCLHD), is working to reduce unnecessary patient travel, to support its target of net zero emissions by 2035.
In 2015, NSLHD established the Spinal Pain Triage Pathway Service as a way of offering better value care to patients referred to spinal surgeons by a general practitioner. The service, located in Royal North Shore Hospital (RNSH), offers non-emergency patients a face-to-face assessment with a triage physiotherapist to determine whether a spinal surgical opinion is required. Less than 25% of patients seen by the physiotherapist require surgical opinion.
An audit conducted in 2019 found that up to 30% of the patients assessed by the triage service live on the Central Coast, an area located 75-120km from RNSH. This indicated a lack of local spinal services in the area, potentially impeding timely patient care and promoting poorer patient outcomes.
This project aimed to demonstrate the viability of offering a satellite assessment clinic at Gosford Hospital for those RNSH spinal pain patients living on the Central Coast. RNSH made a clinic available to patients once a month for a trial period of a year. Travel distances and modes of transport were collected, and data was analysed to determine emissions avoided, as well as time saved and patient satisfaction with the service.
Prioritising accessible care that is good for the planet
Negotiations between the Physiotherapy Heads of Department at RNSH and Gosford Hospital were a fundamental first step to the establishment of the clinic. The project team made a consultation room available within Gosford Hospital, and provided assessment tools for an RNSH physiotherapist to use once per month for a 12-month period. Following ethics approval, we asked patients who attended the satellite clinic which mode of transport they (and their carer if applicable) has previously used to travel to and from RNSH.
The project team used Google Maps to calculate the return distance for patients (and carers, where applicable) to Gosford Hospital in comparison to RNSH, and travel-related carbon emission factors were used to estimate carbon emissions for attendance at Gosford Hospital compared to RNSH.1, 2 A patient satisfaction survey was used to determine effectiveness of the new model. This was sent anonymously to patients following their visit using a QARS survey tool.
Annual saving of 489kgC02e achieved
33 face-to-face encounters occurred at the satellite clinic during the trial period of one year. A majority (91%) of patients reported they would have otherwise travelled to RNSH by car, and 45% would have travelled with a carer. The average return trip to Gosford Hospital was calculated to take each patient 3hr 37mins, compared to 8hrs 51mins for a return trip to RNSH. Therefore, the satellite clinic saved each patient an average of 5hrs 15mins, or 59% of their travel time to RNSH.
All patients were satisfied with the distance they travelled to Gosford Hospital, with 89% stating they would have found RNSH difficult to access due to its distance or their pain limitations. 95% of patients were satisfied with being assessed by a specialised physiotherapist prior to seeing a surgeon, and 84% felt they had gained a better understanding of how to manage their spinal problem. Only 23% of patients required a referral for a surgical opinion. We achieved a 61% saving in patient transport related greenhouse gas emissions by offering care at Gosford Hospital and avoiding transport to RNSH. The average carbon emission saving per patient encounter was 19kgCO2e, which equates to annual total saving of 489kgCO2e.
Satellite clinic facilitates savings for patients
Estimates reveal that the satellite clinic reduced the median return distance travelled by patients by 85%, from 352km travel to RNSH, to 52km travel to Gosford. This equates to an average of $54 savings per patient in the cost of petrol if driving, or a total of $1,774 (based on average fuel consumption and cost).3 This project has demonstrated that offering a satellite triage clinic at Gosford Hospital for RNSH patients residing on the Central Coast saves transport related carbon emissions, patient time and is overall acceptable to patients. Communication between Local Health Districts and executive support was pivotal for the establishment and ongoing success of the satellite clinic. Involvement and training of administrative support staff was also pivotal in facilitating day-to-day functioning of the clinic.
Funding has now been secured for a permanent (part-time) musculoskeletal physiotherapist (level 4) to continue the service. Ongoing partnership between NSLHD and CCLHD will ensure continuity of care for patients that are triaged in the spinal pain pathway.
This project was part of the NSLHD Net Zero Leads Program.
References
- GOV.UK. Greenhouse gas reporting: conversion factors 2023. United Kingdom; 2023. [cited Jul 2024].
- Department of Infrastructure, Transport, Regional Development, communications and the Arts. Transport Energy and Environment. Canberra; 2023. [cited Jul 2024].
- Australian Bureau of Statistics. Survey of Motor Vehicle Use, Australia. Belconnen; 2020. [cited Jul 2024].
