Innovations

In May 2016 rheumatology referrals were outstripping service capacity, leading to increasing waiting times for new patients. Following a review of new patient referrals the team identified that a significant proportion of referrals, though being appropriately referred to rheumatology, were for non-inflammatory conditions. Recognising the changing landscape of the NHS and the emphasis to look at different ways of working we put forward a proposal to pilot a rheumatology advanced practitioner physiotherapist (APP) with the following aims: -

• Improve the triage process
• Streamline the pathway for new patients with non-inflammatory conditions
• Reduce waiting times

It has become more common in Dutch hospitals to outsource the department of allied healthcare to the private sector. This development has affected the department of physiotherapy, being part of allied healthcare, in hospitals significantly and as a result the need for guidance in this new situation has increased. In response to this, the Dutch Association of Physical Therapy in Hospitals (NVZF) conducted a comprehensive study into the process of outsourcing with the objective to inform and advise departments of physiotherapy in hospitals about outsourcing developments. The reason to share this work is that we would like to compare our results from this national study internationally, to exchange experience and knowledge from a broader perspective.

To disseminate the success of this innovative new pathway, delaying knee flexion, to a wider audience.

The current emphasis within the NHS is to safely reduce the time patients spend in hospital and perform more operations as day surgery or short stay. Our aim was to reduce the length of stay (LOS) for all unicompartmental knee replacements (UKRs) by introducing a new pathway with an innovative rehabilitation protocol, delaying knee flexion. This was to help reduce post-operative pain and speed up mobilisation to give as many patients as possible the opportunity to be managed as day surgery cases.

Early rehabilitation of patients in critical care (CC) units demonstrates clear patient benefits for outcomes of physical function, muscle strength and length of stay. Cycle-ergometry as a modality for early rehabilitation is safe and feasible in mechanically ventilated patients once they are medically stable. However, it is widely recognised that implementing such an intervention outside of a clinical trial can be challenging.

Nottingham University Hospitals NUS Trust introduced a protocol for cycle ergometry for all eligible adult patients in CC. The aim of this service evaluation (SE) was to determine whether an early cycle-ergometry protocol could be safely delivered and was operationally feasible. The SE also aimed to highlight any barriers to implementation that were modifiable. The SE was registered with the Trust number 17-239C

Frozen shoulder is a common condition and current guidelines state that it is a diagnosis of exclusion. Along with a history and clinical examination, routine x-ray is mandated to rule out any masquerading pathology such as fracture, dislocation, metastatic lesions or severe OA. Despite the certainty of the guidelines there is a lack of evidence to support the use of routine x-rays in this situation.

To evaluate the implementation of a service redesign for patients with suspected scaphoid fractures. A scaphoid fracture is a diagnostic and radiographic challenge for clinicians with heterogeneity of assessment and treatment nationally. We propose an advanced physiotherapy led model that reduces both direct and indirect costs to the patient, trust and NHS that is shown to be safe and effective.

In 2011 in Scotland, approximately 8% of older people who fell received multifactorial assessment (MFA) and intervention delivered by NHS services. Our aim is to reach 20% by implementing the Falls Framework for Action for Scotland. Tests of opportunistic screening have demonstrated low uptake of MFA; many people don't want - or need - formal intervention from NHS services. A growing number of people over 60 use the internet (59%) with Scotland increasingly investing in technology solutions to improve health and well being. NHS 24's Smartcare Programme, provided the opportunity to explore the use technology to support self-management of falls risk. Our aim was to develop an online self management tool to enable users to assess falls risk and create a personalised falls prevention plan.

• Evaluate the quality and adherence of patients with MSK conditions to agreed exercise programmes when using a digital platform compared to a printed version.
• Evaluate the patient´s experience when engaging with an exercise programme and their interaction with clinicians and any differences related to patient characteristics (age, gender).
• Evaluate the impact on generic patient reported outcome measures (PROMS) (eg PSFS, EQ5D, MSKHQ)

Recent scandals relating to care failings within the NHS have led the UK government to recommend that providers examine the recruitment methods for healthcare professional education programmes and initiate better screening of those entering the professions (Francis, 2013). The School of Healthcare Sciences at Cardiff University has committed to interviewing all applicants prior to enrolment and have instigated a multiple mini-interview (MMI) structure to do so.

In MMIs candidates have many opportunities to make a first impression, meeting different assessors at each station, suggesting the process is fairer and more consistent when compared to traditional panel interviews (Eva et al, 2004). However, if MMIs are designed to select for specific attributes and personalities, do they result in a homogenous student population and thus reduce the diversity of experiences, thoughts and behaviours within? Is the process which is thought to be 'fair' actually fraught with bias?

This project aimed to investigate bias within the MMI structure for Physiotherapy recruitment at Cardiff University. It considers the design and scoring of interview stations and their inclusivity, through the monitoring of performance at each station by applicants with differing characteristics.  

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.