Orthotic Department SWBH-- Access Criteria -- June 2015
The ‘Access Criteria’ for referrals to the Orthotic Department have been examined in light of ‘length of wait’ for appointments and ‘number of referrals’.
Simply put there is an increasing length of time that patients are waiting to be seen to be assessed and provided with orthoses, also there seems to be an
increasing number of referrals to the Orthotic Department further applying pressure on the waiting times. As a Department during Clinical Governance
meetings we have been reviewing our access criteria for referrals. We hope that this will help manage the waiting times for the patient groups that we
NEED to see in a Hospital setting. It is important to note that this approach is supported by the policy of ‘Right Care Right Here’ helping to ensure that
patients are seen in appropriate settings near to their home and to reduce waiting time.
We, as a Department, are aware that there are other routes for provision of some orthoses: Some Occupational Therapists and Physiotherapists will
provide some ’upper limb splints and orthoses’; Some Podiatrists will provide some ‘insoles’; Some nurses will provide ‘upper limb splints’ and ‘compression
stockings’. Thus patients would still have access to assessment and provision, simply not from the Orthotic Department This process of reviewing access
criteria has happened previously with the provision of ‘compression stockings’ which we no longer provide.
As a Department we have discussed the possible impact of this change in access criteria. One effect would be spend on each orthosis, the average cost of an
orthosis is likely to increase as the patients who would continue to be seen in the department would be those that tend to need more expensive orthoses.
This would likely increase the ‘costs per case’ of orthotic interventions for the Department.
Considerations:
1. We first considered our ‘patient population’ and ‘classified’ them uneasily with a mixture of diagnosis and referral source. This is far from ideal but
it gave a working structure.
2. Each of the groups we tried to stratify into three, this represents the complexity of diagnosis, presentation or provision, again an uneasy
classification.
3. The range of interventions that are only carried out by Orthotists? Thus the patient group that we NEED to see.
The access criteria have been presented in a table form, one table for paediatrics and one table for adults. These are not exhaustive guides, details may be
missing and may well need clarification but this does offer a working structure (some abbreviations have been used). It is anticipated that these guidelines
will evolve and gain further clarity as and when required.
Classification of Paediatrics
Paediatrics with a neurological
diagnosis:
 CP
Paediatrics with Muscular Skeletal
conditions:
Green, who we need to see
Issues/Provision:
 KAFOs
 AFOs
 Lycra, CCDs
Issues/Provision:
 KAFOs for Blount’s
Issues/Provision:
 Supporting boots
Issues/Provision:
 Raise for Leg length
differences, quite rare
Red, who we will not see
Issues/Provision:
 Insoles
Issues/Provision:
 Insoles for flat feet, or knee
pain due to over pronation
of feet
Points to note:


Paediatric referrals for insoles should be directed to the Community Foot Health Departments
The Paediatric referrals from Hospital Consultants for insoles will also not be accepted by the Department, in line with ‘Right Care Right Here’
approach
Classification of Adults
Adults with a neurological diagnosis:
 CVA
 MS
 TBI
 Others
Green, who we need to see
Issues/Provision:
 KAFOs
 AFOs
 Lycra, footwear
Red, who we will not see
Issues/Provision:
 Shoulder supports
Muscular Skeletal conditions:
 OA
 Polio
Diabetics
Rheumatoid Arthritis
Vascular
Issues/Provision:
 Significant weakness (polio)
 Significant alignment issues
(for example, knees or
feet/bunions
 Orthoses, various designs
 Footwear, various designs
Issues/Provision:
 Increased risk of ulceration
 Current ulceration
 Amputations
 Charcot joints
Issues/Provision:
 Significant foot deformities
 Bespoke footwear
Issues/Provision:



Staff, referred from Occupational
Health
Hand Splinting
Issues/Provision:
 Leg length differences, for a
raise to shoes
 Alignment issues requiring
more than insoles
Issues/Provision
 Insoles
 Over pronation of feet
 Plantar Fasciitis
 Mortons Neuroma
 General foot pain
Issues/Provision:
 At risk
Issues/Provision:
 Low risk
Issues/Provision:
 Foot deformities
 Modular footwear
Issues/Provision:
Issues/Provision:
 Over pronation of feet
Issues/Provision:
Issues/Provision:
Issues/Provision:
Issues/Provision:
Issues/Provision:
Ulceration
Significant risk
Footwear
Issues/Provision:
 Over pronation of feet
 Plantar Fasciitis
Issues/Provision:
Points to note:


Adult referrals for insoles should be directed to the Community Foot Health Departments
Staff referred by Occupational Health at the Trust will not be accepted if they are referred for insoles, in line with other Muscular Skeletal
conditions