A novel model for a hub-and-spoke spinal service and improvements in the treatment of spinal pathology in a rural hospital setting.

Introduction:   We present a unique pathway for care aimed specifically at spinal patients. As a result of the shift of the spoke direction from the existing hub-and-spoke model, patient care is being redirected successfully with great benefit to a rural department. Within the rural community, it is the spoke that is the main locality to which patients present and at which they are treated. Subspecialty procurement is often more central and located in tertiary referral centres outside of a rural position. This in itself can prove difficult to patients and their relatives because subspecialty treatment, when required, is often only accessed at tertiary referral centers, which can present travel difficulties to patients and their relatives. This is at a time of great vulnerability for patients and families when what is required is more stability and familiarity.

Methods:   We conducted a retrospective cohort study between 15 December 2014 and 21 September 2016. We examined the number of patients that had been seen and treated in both an inpatient and outpatient setting after a change of departmental policy and the introduction of two designated spinal consultants into a rural trauma and orthopaedic hospital in the county of Suffolk in eastern England. Before this introduction, patients were transferred out from this rural setting where inpatient management was required and/or seen in outpatient departments in more central (hub) locations. Over this time, 1413 patients were seen on an elective basis by two spinal consultants and 199 by one of those consultants on an emergency basis.

Results:   This has led to a fruitful integration of spinal care in the rural hospital setting with the introduction of a first-line on-call service, specialist spinal onsite support with commissioned outpatient and trauma facilities, thereby increasing the facilities in the rural hospital setting on a background of continued support from the hub specialist centre.

Conclusions:   This novel approach improves support for existing trauma and orthopaedic surgery departments, increases commissioned facilities within the rural hospital setting and improves the care received on a more local level by patients developing spinal pathologies. This subspecialty service was previously only available within the more central, large city-based hub hospital. After the introduction of a subspecialty spine service, facilities within this spoke rural hospital have increased and access to these services is more available locally to the rural community. This has improved patient care dramatically.