1. See & Treat Ultrasound Foot Clinics Mr R D Ferdinand

2. What will we explore? S B A R Unexpected outcomes

3. Situation “Painful ankle” Old pathway: – clinic, xray, – OPA MRI/USS – Await Test Results – clinic – OPA WL injection – Daycase arthrogram – OPA Definitive plan

4. Situation More than 5 hospital appointments to gain diagnosis Patient pathway prolonged System blocks to patient flow Inappropriate tests Perceived low patient satisfaction

5. Background Single surgeon service Large catchment area Understaffed Radiology service 12 years in post No ultrasound experience

6. Action One stop concept Identify unused machine time 2 day training course in Newcastle Alter triage, educate colleagues 1 in 7 weeks, 30 min slots Audit outcome

7. Example 1 New Pathway – S & T clinic USS, Injection, Definitive treatment

8. Examples Achilles insertional enthesopathy Subtalar injection Peroneal tear Symptomatic Os Trigonum Talonavicular injection Tarso-metatarsal injection Sesamoid pain Morton’s neuroma Plantar fibromatosis Esoteric

9. Results Dramatic reduction in patient journey High patient satisfaction 32 MRIs avoided 23 anaesthetics avoided 1 in 7 weeks insufficient Cost

10. Unexpected outcomes Joint injection Achilles tendon planning Morton’s neuroma accuracy Dynamic peroneal tendon assessment Ankle block accuracy Job satisfaction Clinic time freed for extra surgery

11. Any Questions?