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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A physiotherapy led clinic in the Emergency Department for suspected scaphoid fractures

The purpose of the service evaluation was to assess the management of suspected scaphoid fractures in a new physiotherapy-led scaphoid clinic and to compare the standard of care for suspected scaphoid fractures for patients who were previously being managed by the ED doctors in an ED Consultant clinic. Historically, the suspected scaphoid fractures were being managed in the ED Consultant clinic. After a period of observation and supervised practice, the Advanced Physiotherapy Practitioner implemented a new scaphoid clinic in Dec 2015. A revised pathway for secondary imaging and management was discussed an agreed with the ED Consultants and Consultant Radiologists.

Learning needs analysis of spinal specialist triage practitioners

The South East London and Kent Regional Spinal Network (RSN) aims to provide evidenced-based pathways for management of musculoskeletal spinal conditions from first point of contact through to tertiary care. From 1st April 2018 all non-emergency referrals to secondary care (Pain and Spinal Surgery) must be referred by Spinal Specialist Triage Practitioners (SSTP). GP referrals will not be accepted. This aligns with the National Back Pain Pathway (NBPP) and NICE CG59 guidelines towards improving spinal care, equity of services and commissioning of spine care across the region. SSTPs, predominantly physiotherapists by background, are multidisciplinary (e.g. osteopaths, nurses) and work in primary or secondary care or in interface services run by NHS and Any Qualified Providers (AQP).

There have been calls for the development of a regional training programme and in the long-term, a nationally recognised qualification, to support SSTPs and promote excellent patient care. Current provision of training is fragmented and learning needs unknown. A learning needs analysis is required to allow for development of future training and development.

There are no validated learning needs questionnaires suitable for the specific purpose therefore a comprehensive tool was required.

Physiotherapy Triage Service for Cancer Patients – a service evaluation.

Individuals with cancer experience a plethora of symptoms from diagnosis, through treatment and beyond into survivorship. Allied Health Professionals are uniquely placed to impact upon these symptoms by engaging individuals in rehabilitation. Scoping of rehabilitation services amongst individuals with cancer undergoing haematological and oncological treatment highlighted various issues with fatigue, loss of function, pain and breathlessness. A pilot programme was implemented to address these unmet needs.

Standardising physiotherapy provision for patients with haemophilia

Haemophilia is an inherited bleeding disorder characterized by recurrent bleeding into muscles and joints with longer term effects including synovial hypertrophy and destruction of the articular cartilage. The national service specification for haemophilia states that 'specialist physiotherapists trained in line with the Haemophilia Chartered Physiotherapists Association' (HCPA) should be a part of haemophilia services. Despite this, there is huge variability in funded, protected hours for physiotherapists working in this area across the UK. Implications of inadequate physiotherapy provision for these patients is far reaching, including increased bleeds and subsequent joint damage for patients, increased factor costs, and increased pressure on haemophilia doctors. One of the key objectives of the HCPA is to establish core principles of care, determine the levels of service provision and improve physiotherapy services for people with haemophilia in the UK.

Oxygen and Non-Invasive Ventilation Pathways in an Adult Cystic Fibrosis Centre

Cystic Fibrosis (CF) is a genetically inherited condition affecting more than 10,000 people in the United Kingdom. A progressive cycle of infection and lung damage occurs. Worsening lung function results in hypoventilation and ultimately leads to respiratory failure that may require supplementary oxygen and/or mechanical support such as Non-Invasive Ventilation (NIV). Guidelines support the use of NIV for nocturnal hypoventilation, hypercapnic respiratory failure and as a bridge to transplant. At the time of development, there were no published guidelines on the use of oxygen therapy in CF and no published pathways on the set up and management of supplementary oxygen or NIV in CF. This special interest report documents the development of separate oxygen and NIV pathways through interdisciplinary working in an adult CF centre.

Objective To develop pathways for supplementary oxygen and the set up and management of NIV in an adult CF centre.

Trial of diagnostic ultrasound in the orthopaedic setting

Historically, provision of MSK Ultrasound diagnostics has been via a referral to Radiology. However, there is increasing evidence that assessment, investigation and initiating treatment at the initial appointment is shown to be cost-effective, increasing patient satisfaction. Utilising this approach also reduces repeated hospital visits for further diagnostics and appointment times for results. The aim of using Point of Care (POC) ultrasound is to enhance the patient experience through instant access to diagnosis, timely implementation of most appropriate clinical pathway and achievement of the optimal outcome in the shortest possible time.

This study aims to investigate the benefits of point of care (POC) and schedule ultrasound clinics using a proof of concepts approach in the orthopaedic setting.

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.