Wasting everyone’s time – an observational study of current practice after injections

C. Flood, A. Carne, B. Singh, M. Solan

Introduction: Injections are offered to thousands of patients suffering with a range of musculoskeletal conditions every year. Most are cortisone injections. Each injection serves both a diagnostic and a therapeutic purpose. The initial response to injection (Local Anaesthetic) helps confirm the clinical diagnosis. The duration of pain relief (steroid) is unpredictable. These dual goals make planning follow-up appointments difficult. A delayed appointment might affect patient recall about the extent of initial benefit. At an early review, the benefits will usually still be apparent, precluding useful planning. As a prelude to improving efficiency, we sought to establish current practice in our region of the UK, and among the BOFAS membership.

Methods: An online questionnaire was administered to clinicians who treat patients with injections.

Results: 256 responses were included in the analysis. These included 138 foot & ankle surgeons and 119 other specialists. Foot & ankle surgeons mostly administer injections in theatre (40.5%) or the imaging department (35.7%). In other specialties outpatient department injections predominate (54%). This may reflect the diagnostic intent and anatomical complexity of injections in the foot and ankle setting. Routine follow-up appointments were given in >80% of cases for first injections and >50% of subsequent injections by all clinicians. Routine appointments are almost all at six to twelve weeks post-injection. This is the case for first and subsequent injections. At follow-up, the vast majority of injections were still working. Immediate pain relief and duration of effect are the most influential factors when planning further treatment.

Conclusion: This data shows that the traditional six to twelve week follow-up appointment after injection is inefficient, and therefore a waste of both clinician and patients’ time. Strategies to record pain scores and invite review only when the benefits of injection have faded have the potential to save millions pounds of healthcare costs.