Innovations

There is strong evidence to support the provision of specialist and intensive rehabilitation programmes (BSRM 2014) and that the highest level of neurological recovery occurs within the first three months post injury (Broeks et al 1999, Feys et al 2000). However, clinical data from our patient cohort showed patients were not commencing rehabilitation until after this time window due to delays in access to specialist rehabilitation, specifically our local district general patients would wait on average 87.3 days, and patients awaiting repatriation to local hospitals would wait 35 days from being medically stable before transfer. On analysis of our patient caseload, 70% of the caseload had a Rehabilitation Complexity Score of more than 10 indicating a complex specialist service as determined by Turner- Stokes et al (2007), however our staff to patient ratio fell significantly short of the recommendations for this level of service. Funding for this service type traditionally comes from NHS England. It was hypothesised that these delays and service parameters impacted on patient’s functional outcome and on the wider health economy.

This service pilot aimed to examine whether provision of specialist rehabilitation to neurological patients receiving hyper-acute neurosciences care would result in clinically significant functional improvements and reduce length of stay, and transfers to specialist facilities.

Increased customer satisfaction is associated with reduced complaints, a positive business reputation and often financial return. Within the clinical setting it has more importantly been shown to have a direct correlation with improved clinical outcomes. The therapeutic relationship is one area that can impact on a patients overall experience and their engagement in treatment. This relationship can be improved by making sure that the patients expectations and perceptions are not only acknowledged but clearly understood. A number of physiotherapists identify that they struggle with changing mind-sets of their patients or find that they are unprepared for having those difficult conversations. Supporting physiotherapists to have effective communication skills, the ability to listen and engage and have awareness of the impact of verbal and non verbal cues is essential in improving the patient experience. Training was required to address the gap in skill and knowledge.

The primary objective for sharing our activity via a Special Interest Report is to illustrate the need for independent measurable compliance of all physiotherapy services against HCPC and CSP Regulations and Standards.

Currently the HCPC re registration focus is on continuous professional development and the Care Quality Commission does not have jurisdiction to regulate standalone physiotherapy services: Therefore, all other regulatory checking is undertaken and reliant on the individual alone. The secondary objective of is to encourage physiotherapists to consider in depth and ensure they appreciate what are they stating, what they agree they are doing when they reregister and sign to state that they comply with all standards and regulations? Could auditing prove that this was the case and, if not, then why are they signing?

Most low back pain (LBP) does not need specific or specialist treatment and will often resolve if people follow simple evidence-based advice. Access to this advice is inconsistent with people often self-managing via untrusted resources online. Using digital technology to provide immediate day-by-day support whilst connecting people to their local MSK pathway and support services, has the potential to deliver trusted evidence-based advice in a consistent and standardised way. We are introducing a self-management solution (getUBetter) into the routine care of patients with LBP. Implementation should lead to quicker recovery, better outcomes, and a reduction in overall healthcare spend.

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.