MSK ICATS Surgical Conversion Rates Demonstrate Effectiveness

The MSK ICATS service in Brighton & Hove has seen surgical conversion rates rise, while waiting times have fallen.

MSK ICATS Partnership Logos

What are surgical conversion rates and why are they important?

Surgical conversion rate is the number of patients who ‘convert’ to having a surgical procedure the first time they see a consultant in secondary care. The DoH and NHS Institute suggest that they can be a good indicator of how well MSK ICATS services are performing. An effective ICATS service would expect to see a higher conversion rate to surgery compared with the rate before the ICATS service.

The purpose of ICATS is not to prevent surgery but to ensure that only patients who are likely to require a surgical procedure progress to a consultant surgeon appointment in hospital.  The patient sees the right person (in this case the surgeon) at the right time.  The ICATS services screen out the patients who are not willing or able to have surgery.


Measuring Change

Using the spine ICATS service as an example, before ICATS existed, only 8% of patients who saw the orthopaedic surgeon went on to have surgery. A very large number of those patients, after waiting 6 months to be seen, would be sent on to a physiotherapist or the other services and join a new waiting list. The advent of the spine ICATS service in Brighton & Hove has seen the conversion rates in spine rise to 48% and the waiting time to be seen in ICATS clinic fall to 4 weeks. 


Spine surgical conversion rates:

Spine Surgical Conversion Rates


Improving the Patient Pathway

As a result of triaging, only a very small proportion (<5%) of patients are directed to secondary care.  Most patients are either triaged to physiotherapy or are seen by an extended scope physiotherapist (ESP) in the ICATS service.  An ESP can investigate and diagnose a patient’s condition. Of course some patients who see ESPs go on to see a consultant and have surgery.  In most cases the patient will have been "worked up" with the appropriate investigations already completed and thus shortening the patient pathway.


Pathway pre-ICATS:

Time to first appointment: 18 weeks



Pathway post-ICATS:

Time to first appointment: 4 weeks


Orthopaedic surgeons have commented, that now their clinics have far fewer inappropriate patients which allows them to focus on patients that do need their attention and that their waiting times have fallen drastically:

 ‘Anecdotally I knew the ICATS service had made a positive impact, now this surgical conversion rate data demonstrates that working in partnership with BICS and SCT to deliver the ICATS model has benefited patients and the health economy. My clinics now have a higher proportion of appropriate patients, who now arrive having had the right diagnostics.’

Cameron Hatrick, Consultant Orthopaedic Surgeon & MSK Clinical Lead for BSUH

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Updated 19/10/2012