Policy Report

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


Erden Ali1 MD, Doctorate Student *

Andrew Macdowell2 FRCS, Consultant

Thomas Pagonis3 FRCS, Consultant


1 Universty of Cambridge, Magdalene College, Magdalene Street, Cambridge CB3 0AG, United Kingdom

2, 3 Broomfield Hospital Court Road, Chelmsford, Essex, CM1 7ET, United Kingdom

ACCEPTED: 12 June 2017

early abstract:

Context: 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 are treated. Subspecialty procurement is often more central and located in tertiary referral centers outside of a rural position. This in itself can prove difficult to patients and their relatives as when further subspecialty treatment is required, this is often only accessed at tertiary referral centers which means much more difficult travel consideration to patients and their relatives. This is at a time of great vulnerability to patients and families at a time when what is required is more stability and familiarity.
Issue: We conducted a retrospective cohort study between 15/12 2014 and 21/09/2016. 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 2 designated spinal consultants into a rural Trauma and Orthopaedic Hospital was examined. 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 2 spinal consultants and 199 by one of those consultants on an emergency basis. This has led to a fruitful integration of spinal care in the rural hospital setting with the introduction of a 1st line on-call service, specialist spinal on site support with commissioned outpatient and trauma facilities thereby increasing the facilities in the rural hospital setting on background of continued support from the hub specialist centre.
Lessons Learnt: 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 by patients developing spinal pathologies on a more local level. This subspecialty service was previously only available within the more centrally, 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 which has improved patient care dramatically.