Transforming the Hand Surgery Assessment Pathway in the Western Isles


NHS WI Tec Team, Orthopedic Team and NHSGGC Royal Infirmary based Orthopedic Hand Surgeon Grzegorz Sianos worked together to transform the hand surgery pathway for island patients. The development of the first in the country Hand Surgery Video Clinic based on the Attend Anywhere platform aimed for efficient use of the resources, patient centered service, and cost-effectiveness.

The project follows principles accepted and promoted by the Scottish Access Collaborative including Active Clinical Referral Triage, providing face to face appointment only if there is a clinical value, and avoiding unnecessary travelling.

Extended scope practitioner Innes Morton (right) runs the clinics with Grzegorz Sianos (pictured on screen).

Mr Sianos is working with Innes Morton, an extended scope practitioner physiotherapist at the Western Isles Hospital in Stornoway, to offer online patient assessments through the real-time video clinics.

This new set-up allows patients in the Western Isles to receive an initial diagnosis at the local hospital with Mr Innes, with Mr Sianos contributing his expertise via the video link. This eliminates the need for patients to travel to mainland Scotland for a face to face consultation.

Furthermore, the video clinics also serve to keep waiting list times down as patients can be more efficiently scheduled in and most of diagnostic as well as non-surgical treatment solutions are to hand.


Innovations in Technology

The use of a hand-held high definition camera enables the local healthcare practitioner to conduct the examination with remote expert input from the surgeon. With most of the clinical information available online via Electronic Patient Records including access to the patients’ X-rays through a PACS system, a diagnosis and treatment plan can be quickly decided upon and instigated.

If the treatment plan is non-surgical, for example if a steroid injection is required, then this can be done during the video consultation.

If surgery is necessary then the consent is obtained from the patient during the same video clinic appointment.

When a patient is scheduled for surgery, the pre-op procedures are all completed in the Western Isles, meaning that the patient has to make just one trip to the mainland for the actual surgery.


Project Progress and Feedback

In December of 2017, the first test trial clinic for the project took place at the Western Isles Hospital in Stornoway with promising results. Since then, with implementation in real cases with patients, feedback has been excellent and the value of this technology is consistently evident.

The first clinic involving patients took place in April of 2018, during which eleven patients participated. It was determined that seven of these patients would require surgery. This first clinic alone created a saving of over £3000 in travel expenses. Since then the clinics are held quarterly allowing for the waiting time target to be met.


Putting Patients First

There are multiple reasons why it may be preferable for a patient to use this service, rather than to see a specialist in person. Although it is a preference for some patients, for others it can be a necessity. The video consultation service makes expert healthcare accessible to a much larger group of people, and is already changing lives for the better.

Video clinics have long been utilized in other areas of medicine, and it is apparent that the potential to enhance orthopedic treatment also exists!


Recognition and Award

Our project to transform the hand surgery assessment pathway in the Western Isles is the perfect example of how Realistic Medicine strives to best support patients, and how we are at the forefront of revolutionizing healthcare in Scotland.

This initiative won the Innovative Remote and Rural Services Award, as part of the Digital Health & Care Awards in Holyrood in February of 2019.