Innovations

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Innovations - quality assured physiotherapy initiatives

Our quality assured examples of successful initiatives aim to promote physiotherapy as an innovative and cost effective approach to improving patient pathways and promoting public health. We welcome examples from all aspects of physiotherapy practice, research, education, and service delivery.

You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. 

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Use of a patient reported outcome measure with acute adult in-patients receiving physiotherapy

The use of outcome measures is well evidenced and documented. Despite prevalent use of various clinician reported outcome measures (CROMs), patient reported outcome measures (PROMs) are often in the form of detailed quality of life questionnaires, which are not appropriate in acute, fast paced environments. A new PROM tool (called thera-PROM) was devised and used with the aim of measuring the effect of goal-focused physiotherapy interventions in an acute adult in-patient setting. Process and data evaluation aims to identify standards and guidelines for future use to support service evaluation and quality measurement.

The small scale project was carried out as a starter to implement an appropriate PROM tool for the clinical area where there was not previously any PROM tool used as it had not been possible to identify an existing PROM tool that was fit for purpose.  The findings may be useful to share with other therapists for wider use or consideration when implementing a PROM tool.

The East Lothian Discharge to Assess Service

Unnecessary delay in discharging patients from hospital is a systemic problem with a rising trend. In 2016/17 there were 532,423 bed days occupied by medically fit patients in Scotland. Over 70% were aged over 75. Current evidence highlights correlation between longer hospital stays and potential harm, resulting in poorer health outcomes, an increase in long-term care needs, poor patient flow and avoidable use of acute resources. Discharge to Assess (D2A) is a national driver and within East Lothian we looked to develop a pathway that supports discharging patients that are clinically fit and appropriate to have their Physiotherapy/Occupational Therapy assessments at home. We aimed to embed D2A as a core East Lothian service and promote a culture of 'ownership' of East Lothian patients throughout their patient journey.

Implementing an occupational healthcare model

Approximately 20,000 sick days (1500 staff members) at St. George's University Hospitals NHS Trust (SGUHT) are due to musculoskeletal issues. This costs the trust approximately £3.4 million per year. Despite this it is the only trust within inner London that, currently, does not have a physiotherapy service within their Occupational Health (OH) offering. The argument for delivering the service is clear, supported by previous research, service evaluations and local data analysis.

Measuring Outcomes in MSK: Analysis of Practice and Recommendations for Development

Clinical outcomes are a vital part of understanding quality in healthcare. As part of this, a large Musculoskeletal (MSK) physiotherapy department in Hampshire has measured the clinical outcomes for all of the patients referred into the service. The outcome tool employed was the MSK-HQ (Musculoskeletal Health Questionnaire), a 14 point outcome measure developed to identify and measure the multi-dimensional aspects of musculoskeletal pain. A multi-dimensional tool was chosen to reflect the complexities and co-morbidities that patients with musculoskeletal conditions commonly present with. The MSK-HQ is a tool that can identify the impact that physiotherapy has had on patient health and well-being as opposed to their musculoskeletal complaint in isolation. The aim was to use the data to improve working practices within the service.

A musculoskeletal single point of referral in primary care

A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013). This was coupled with the implementation of online self-referral for physiotherapy and occupational therapy, where patients were issued advice and exercise within 24 hours. Advice and exercise are issued for patients triaged for physiotherapy through the single point of referral. AHPs are responsible all patient administrative tasks and provide the triaging clinicians. NCHC provide clinical physiotherapy, occupational therapy and orthopaedic triage services. This is contracted to the Norwich and South Norfolk Clinical Commissioning Group and they set key performance indicators for patients being seen. Routine patients to be seen in 28 working days, urgent patients to be seen in 7 days and orthopaedic triage patients to be seen in 14 working days.

Management of atraumatic shoulder instability

There is limited published evidence to guide physiotherapists when treating patients with atraumatic shoulder instability. The aim of this study was to update the results of a previous small service evaluation investigating the outcomes for patients following a specific structured physiotherapy programme.