Complex regional pain syndrome: A new model of care improving patient outcomes

Miss Zoe Milner1, Miss  Hayley O’Sullivan1, Assoc Prof Malcolm Hogg2, Dr Bethany White2

1Dept of Allied Health, Royal Melbourne Hospital, Parkville, Australia

2Dept of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia

Background:

Complex regional pain syndrome (CRPS) is a painful and functionally debilitating condition associated with sensory and motor abnormalities. Patients presenting with signs and symptoms of CRPS within Royal Melbourne Hospital (RMH) were frequently not identified, resulting in multiple presentations to the emergency department (ED) and high healthcare utilisation. These patients received care in silos, which lacked co-ordination.  Furthermore, most patients that presented with signs and symptoms of CRPS developed chronic CRPS, experiencing long term pain and poor hand function.  Many patients required involvement with Melbourne Health months or years after their injury.

Aim:

To provide intervention in a co-ordinated, evidence based and well supported approach, reducing variation in care and reducing healthcare utilisation

Methods:

With the support of a Department of Health & Human Services Allied Health Workforce Advanced Practice grant a new management pathway was developed and implemented at RMH.

Results:

Preliminary data analysis is extremely positive with improvements in clinical outcomes and reductions in healthcare utilisation. On average:

  • Presentations to the emergency department for pain reduced from 4 to <1
  • Inpatient admissions reduced from 1 to 0.1 (i.e. 1 presentation every 10 patients)
  • Surgical consults reduced from 14 to 4
  • Chronic pain appointments reduced from 9 to 0

Significance of findings to allied health:

Hand therapy in collaboration with pain management services, developed and implemented an innovative clinical approach to the management of patients with signs and symptoms of CRPS. This model provides a single point of contact and enables patients to access the right care at the right time. This model of care has demonstrated its effectiveness by reducing healthcare utilisation, improving patient access to care and improving patient outcomes.