ROYAL PRESTON HOSPITAL VIRTUAL SPINE ADVISORY SERVICE
Zehong Chen, P Veerappa, M VadhvaNo conflicts of interest
No funding obtained
Background
Long waiting times for spinal outpatient clinics remain a significant challenge, with national guidance highlighting outpatient pathways as a key opportunity for improvement. At Royal Preston Hospital, patients with spinal pathology face waits exceeding 12 weeks for first appointments.
Aim
To evaluate the implementation of a Virtual Spine Advisory Service (VSAS) as a quality improvement initiative to optimise triage, reduce unnecessary surgical referrals, and improve patient flow.
Methods
Since January 2026, a monthly multidisciplinary virtual triage clinic has been piloted for East Lancashire Hospitals Trust referrals (opt-in). The service includes a spinal surgeon and MSK practitioners, with structured review of clinical presentation and MRI findings. Outcomes included referral to spinal surgical clinic, or continuation of conservative management (pain management and physiotherapy). All discussed cases were documented and patients received written feedback.
Results
Sixteen patients were referred during the pilot period; thirteen were discussed (mean age 54 ± 17.1 years; 6 female, 7 male). Two patients already had clinic appointments and one improved prior to review. Ten patients (62.5%) were referred for surgical consultation. 37.5% avoided onward surgical referral, enabling early redirection to appropriate conservative pathways.
Conclusion
The VSAS model demonstrates potential to streamline spinal referrals, reduce unnecessary outpatient appointments, and improve pathway efficiency through early specialist triage. This approach may enhance accessibility, reduce chronicity of symptoms, and improve cost-effectiveness. Limitations include reliance on MSK physiotherapy assessment and potential patient dissatisfaction. Expansion across additional regions is planned.