Escalation within MSK | Right Decisions

On occasion a patient’s care may not be progressing as anticipated, or, if during treatment there is change or cause for clinical concern, a robust process is in place to enable timely escalation of care. The escalation process enables second opinion and support, or access to necessary investigations where supported by clinical guidelines.

The MSK clinician should:
Discuss case and/or concerns with clinical lead or APP and document outcome of conversation.

If patient is already under the care of a consultant they should be your point of contact. If unsure discuss with clinical lead or APP.

MSK clinical lead

• XR for OA diagnosis.
• XR for potential bony injury or calcification
• 2nd opinion regarding diagnosis
• 2nd opinion regarding rehabilitation
• Injections
• Suspicion that NCS may be required (hand pathway)

Patient directly appointed with escalation form completed

Advanced practitioner clinic

• Clinical concern/Red flags
• Work up for potential surgical opinion beyond plain film
• Differentiation between spinal/peripheral joints
• Investigations for Peripheral neurology
• Pain Specialist Physiotherapist
• 2nd opinion regarding diagnosis

• Ultrasound Tendon pain not responding to rehabilitation
• Guided injections
• Synovitis assessment
• Tendon tears if surgery likely to beconsidered

Referral to the APP clinics should be made via MSK escalation mailbox (refer to SOP) APPs will decide most appropriate clinic based on clinical information provided.