Healthcare is generally organised around individual clinics and services rather than the individual needs of a patient. A person may see their GP or physiotherapist, obtain a referral, wait for a specialist assessment, attend another provider for imaging and then return for review If surgery is required, another referral begins. While each step may be clinically appropriate, the overall process can take weeks and require several days away from work, school or family commitments. Rehabilitation may be delayed while the patient remains uncertain about the diagnosis, what activity is safe and whether surgery will be needed.

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We established the Axis Acute Knee Clinic because we thoughts this process could be better.

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Bringing the pathway together

Our knee clinic combines specialist assessment with access to physiotherapy, imaging and surgical referral through one coordinated pathway. Patients are assessed by a sport and exercise physician working alongside one of our physiotherapists. If imaging is required, it can usually be arranged that day. The scan can then normally be reviewed and a treatment plan confirmed within 24 hours of the first consultation. If surgery is needed, the patient can have an expedited appointment with an appropriate knee surgeon, with the specialist assessment and imaging already completed.

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Early diagnosis also allows practical decisions to be made. Patients can receive appropriate bracing., begin targeted rehabilitation and obtain clear advice about work, driving and sport. Injuries requiring urgent surgical input can be identified, while thought suitable for non-operative treatment can avoid an unnecessary surgical consultation.

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Saving patient days

Healthcare organisations and clinicians measure many outcomes, including waiting lists, appointment numbers, treatment costs, complications and patient-reported scores. These are all important, but they do not always capture what matters most to patients: how quickly they recover and how much of their time is consumed along the way. Patients experience more than the time recorded on a waiting list. They spend time travelling, finding parking, reorganising work or school, arranging childcare and attending appointments across different locations. Delays between assessment, imaging and review can also postpone diagnosis and appropriate rehabilitation. Some of this time is necessary for good care, but time spent repeating assessments or waiting for the ne4xt predictable step adds no value. A patient-centric pathway should therefore aim to shorten the overall journey to recovery while minimising avoidable appointments, travel and uncertainty.

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The aim is not to provide more care of scan every knee. It is to make the right decisions earlier and remove gaps that do not add clinical value. Our data show that more than half of patients who required MRI had their scan on the day of their first specialist consultation. Clinics like ours have been shown to reduce the time to diagnosis by 89% compared to traditional pathways, while early imaging has been associated with greater patient satisfaction, less pain and fewer activity limitations, at a similar overall cost to conventional care.

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Extending the approach

We started with acute knee injuries because the clinical pathway was generally predictable and the delays were obvious. We are now applying the same principles to acute shoulder injuries, including dislocations, instability and acute rotator cuff injuries. We have a similar approach to other conditions where patients repeatedly move between clinical assessment, imaging, rehabilitation and surgical options. Unfortunately developing these pathways is not always straightforward, partly because existing funding and referral models often pay for individual services rather than coordinated episodes of care.

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Patient-centred care is not only about the interaction during a consultation. It also means respecting the patient's time and designing a clear route through the system. Better care does not always require a new treatment. Sometimes it requires us to connect the services we already have more effectively. If you have sustained an acute knee or shoulder injury, ask your GP, physiotherapist or urgent-care clinician to refer you to the relevant Axis acute injury clinic. Our team can coordinate specialist assessment, imaging, rehabilitation and surgical referral when required, helping your move from injury to a clear treatment plan with minimal delay.