Dr Marie O’Mir: Improving waiting times and reducing costs in paediatric orthopaedics

Dr Marie O’ Mir is an advanced practice physiotherapist in the Department of Paediatric Orthopaedics at Children’s Health Ireland (CHI) at Crumlin.

Advanced Practice Physiotherapists (APP), like Marie, are specialist physiotherapists who perform some tasks traditionally performed by orthopaedic consultants (e.g.) patient assessment, diagnosis and treatment, joint injection, removal of casts and K-wires, and listing for surgery in some instances. APPs have been used to good effect in adult medicine as a means of delivering high quality care to musculoskeletal patients.

Musculoskeletal complaints (conditions affecting muscles, bones, ligaments, tendons, and nerves) account for 1 in 8 of all visits by children and adolescents to their primary care physicians. A significant proportion of the complaints are conditions such as flat feet, in-toeing, out-toeing, knock knees/ bow legs. These “normal variants” account for 50% of elective referrals to paediatric orthopaedic surgeons and have been described as inappropriate surgical referrals. These conditions resolve spontaneously with normal growth and development and do not require specialist intervention.

Marie established an APP Orthopaedic Triage clinic at CHI at Crumlin in response to the increasing demands on the paediatric orthopaedic service and rapidly expanding waiting lists. CHI at Crumlin was the first Irish Institution to implement this service. Approximately 2600 elective orthopaedic patients were managed by the APP Triage Clinic over a three-year period between January 2011 and December 2013.

For her PhD, Marie performed a review of the clinic over a 3-year period (January 2011 – December 2013) to assess the effectiveness of the APP Orthopaedic Triage clinic at CHI at Crumlin. Since its inception, the clinic has significantly reduced waiting times for paediatric orthopaedic patients, with most patients being independently managed by the APPs without need for consultant involvement. There was an average of 87-week reduction in patient waiting times for consultation. The level of diagnostic agreement between the APP and the orthopaedic consultant was extremely high. The APP service was more cost effective, resulting in a €24.51 saving per appointment.  Consultants, referrers, and parents all rated the service as “excellent” when surveyed. Consistent with their high level of satisfaction, parents indicated that they were willing-to-pay to attend an APP clinic by an amount that far exceeded appointment costs.

Marie’s study has shown that APPs can deliver high quality care in the paediatric orthopaedic setting, benefiting both patients and service.

Marie recently won best oral poster presentation at the NCRC annual symposium 2019 for her research on “The efficacy of an advanced practice physiotherapy triage service in paediatric orthopaedics: innovation and collaboration to improve service delivery”. (l-r) Dr Jacinta Kelly (CEO of the NCRC), Denise Fitzgerald (CEO of Children’s Health Foundation), Dr Marie O’ Mir, and Wendy Costello (Chairperson of the Irish Children’s Arthritis Network).

Marie was funded through the National Children’s Research Centre Research Education Support Grant to undertake a PhD under the supervision of Dr Cliona O’Sullivan (School of Public Health, Physiotherapy and Sports Science, UCD) on her research project “The efficacy of an Advanced Practice Physiotherapy Clinic in Paediatric Orthopaedics”.

You can read more about Marie’s research through the following links:

Mír, M. Ó., Cooney, C., O’Sullivan, C., Blake, C., Kelly, P., Kiely, P., Noel, J. & Moore, D. 2016. The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics. Journal of Children’s Orthopaedics, 1-7. (Pubmed)

Mír, M. Ó., Blake, C., Lennon, O. & O’Sullivan, C. 2018. An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints. Musculoskeletal Care, 16 , 433-439. (Pubmed)

Mír, M. Ó., O’Sullivan, C., Blake, C. & Lennon, O. 2019. An Exploration of Parental Satisfaction With an Advanced Practice Physical Therapy Clinic in Pediatric Orthopedics. Pediatric Physical Therapy, 31, 192-199 (Pubmed)

Mír, M. Ó., Slawa Rokicki, Lennon, O., Toole, P. O. O., Desmeules, F. & O’Sullivan, C. 2019. An Advanced Practice Physiotherapy Clinic in Paediatric Orthopaedics: A Cost Minimisation Analysis. Physiotherapy Practice and Research. (Link)

Mír, M. Ó. & O’Sullivan, C. 2017. Advanced practice physiotherapy in paediatric orthopaedics: Innovation and collaboration to improve service delivery. Irish Journal of Medical Science (1971-), 1-10. (Pubmed)