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.
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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.
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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.
To evaluate the effectiveness of a community based Exercise After Stroke Group (EASG) in patient outcomes and service delivery.
The survey was intended to give a snap shot of what was happening in stroke services across Scotland to help inform the CSP ´Rehab Matters´ campaign.
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 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.
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.
Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of this study was to establish the current UK practice in managing patients with chronic tennis elbow (symptoms over six months).
Collaborating with council services to encourage people with low back pain to self-manage in community settings
Moving care out of hospital settings and into the community is a key focus of the NHS Five Year Forward View. We explored if it was feasible for NHS physiotherapists to deliver free back classes within local council leisure centres, and if they effectively helped to increase participant activity levels. A review of the back pain pathway within Wiltshire generated a desire to use a stratified approach to interventions. We chose to begin with those scoring low risk on the STarT back tool, aiming to deliver messages to foster a positive approach to exercise and prevent unhelpful beliefs developing. This service evaluation will inform the wider back pain pathway in Wiltshire and may provide insight to other physiotherapists planning similar projects.
Evaluation of treatments and outcomes, red flags and signs and symptoms for cervicogenic headache in a musculoskeletal setting
Current evidence advocates physiotherapy treatment, for the management of cervicogenic headaches (CGH). A reasoned assessment and clear knowledge of red flags is essential.
An MSK physiotherapy team from southern England received training sessions for CGH. Topics included assessment, evidence based treatment, clinical reasoning and red flags. Physiotherapists completed a questionnaire on headache red flags and signs and symptoms, preceding and following training.
10 patient cases were examined, exploring treatments, against current best practice, after training. Effectiveness was evaluated using patient outcomes before and after intervention.
The purpose/objectives of this study was to:-
- Evaluate participant's knowledge of red flag and signs and symptoms of CGH headache, preceding and following training.
- Examine treatments used by participants for 10 CGH patient cases, against current best practice after training.
- Review patient treatment outcomes, of the 10 CGH patient cases after training.