Advanced MSK Podiatrist, Department of Podiatry, Solent NHS Trust
The Integration of Diagnostic Ultrasound into Podiatry
Who am I?
I am a Band 7 Advanced musculoskeletal (MSK) Podiatrist working for Solent NHS Trust. I qualified in 2004 from the University of Southampton. I work primarily within MSK but also maintain my involvement in ‘At Risk Foot’ clinics supporting patients with complex health needs and foot wounds. In particular, I have a keen interest in the Rheumatic diseases and their manifestations within the foot and ankle.
What is my Role?
My role is primarily clinical in nature where I manage a high case load of patients presenting with a vast array of MSK complaints relating to the lower limb including the hip, knee, foot and ankle.
I often have to undertake complex assessments, interpret a range of clinical findings and create care plans to help improve lower limb health and/or mobility. This often requires onward referral for imaging and other investigations to aid my decision making and future care planning. With my clinical experience and frequent need to request imaging I was well placed to take on the lead role for the ‘US in Podiatry’ project.
What is the Ultrasound Project?
Currently patients with complex MSK foot health problems can be referred into a specialist service. However, at present the service has no dedicated access to imaging to support clinical diagnosis or treatment decision making. Due to the anatomical complexity of the foot, clinical examination alone has been shown to be inferior to clinical exam plus diagnostic musculoskeletal ultrasound (US). As such, patients are referred into secondary care services for US imaging. This may result in, at minimum, two further appointments for the patient, both in the hospital setting for the scan to be completed and again in the specialist clinic, before the findings can be implemented into a care plan.
Our patients told us that they would prefer if the specialist Podiatrist that they saw initially could also complete the US scan and start to create a plan within the same visit. Thus, it would potentially be practicable, time-saving, and more cost-efficient if the treating physician were able to undertake or access this imaging modality as part of their community-based practice, to aid real-time decision making and treatment planning. There is also growing evidence to suggest that the clinical efficacy of diagnostic ultrasound performed by the treating physician can add significant clinical value to a consultation. This has been attributed to the clinician being able to visualise, interpret and embed the added information given as part of a holistic patient assessment and care package.
The main aim of this project is to determine whether Podiatrists can safely and competently introduce ultrasound into an area of MSK podiatric practice. The objectives are therefore to:
1. Complete an accredited training course in musculoskeletal US
2. Complete a baseline service evaluation to identify the potential impact of a change in service to include chair-side US exam
3. Consult patient partners and their friends/family with regards to their experience of the current service and contribution to the design of an alternate pathway including Podiatrist completed US examination
4. Utilise learning from objectives 1-3 to work with senior management to devise an implementation strategy for US into podiatric practice
5. Complete a further programme of service evaluation and audit to determine the impact upon patient care in terms of safety, efficacy, quality (including patient satisfaction, clinical outcome & timeliness of intervention), and cost effectiveness.
Further information
- Funding for this training has been provided through a Solent NHS Trust internship, supervised by Dr Lindsey Cherry, with support from the Department of Podiatry Services Manager, Graham Bowen.
- The other US group members from Solent NHS Trust include Steve Jones, Rachel Ferguson and Charlotte Dando
- CASE accredited training is being provided by the Anglo-European College of Chiropractic, Centre for Ultrasound Studies
For more information about this project please contact either Jon Bailey jonathon.bailey@solent.nhs.uk or Dr Lindsey Cherry l.cherry@soton.ac.uk
To find out more about how to get involved with other areas of service improvement or if you have an improvement idea that you would like to share please contact Sophie Gay sophie.gay@solent.nhs.uk