The number of thoracic surgical procedures performed in the United Kingdom continues to increase annually putting pressure on thoracic surgical bed capacity. Reducing hospital length of stay (LOS) following thoracic surgery can help to reduce pressure on hospital beds. The purpose of this service evaluation is to explore hospital and physiotherapy LOS for individuals following thoracic surgery at our hospital and identify whether any factors influence hospital and Physiotherapy LOS. The findings could potentially allow the identification of individuals at risk of longer LOS and help direct physiotherapy rehabilitation provision to these individuals.
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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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Referral from primary care musculoskeletal services to Accident and Emergency for suspected cauda equine syndrome
Cauda equine syndrome (CES) is a medical emergency, requiring immediate referral for investigation and early surgical decompression for a favourable outcome (1). Southern Health NHS Foundation Trust (SHFT) musculoskeletal services manage suspected CES with immediate referral to accident and emergency (A&E) at the University of Southampton NHS Trust (UHS) where urgent imaging and surgical decompression can take place.
This evaluation aimed to describe the demographics and clinical features of referred patients, plus summarise the medical management and clinical outcome following A&E examination.
Impact of a physiotherapy general rehabilitation class on patient outcomes with lower limb pathology
The aim of the service evaluation was to assess the impact of a 6 week general rehabilitation class has on patient functional and pain experience outcomes.
Impaired mobility and balance correlate strongly with an individual's function and overall state of health. The Hierarchical Assessment of Balance and Mobility (HABAM) is a graphic and rapid assessment of balance and mobility originally designed for use within the hospitalised elderly. The measure has been used predominantly within frail elderly populations; however the aims of this study were to assess the utility of the HABAM to an elective orthopaedic population.
Physiotherapy self-referral has risen over the last 2 years in our hospital trust to almost 50%. As referral numbers have increased so has the ways in which people can access the service. The purpose of the evaluation was to examine the way in which people access the self referral service with a view to improving the efficiency of the service, the ease of access for patients as well as ensuring a fair and safe service.
To explore the impact of putting senior clinicians at the bedside with clinical expertise in their speciality to improve quality of patient care. This role was introduced at Hampshire Hospitals Foundation Trust (HHFT) in 2016, whilst mainly undertaken by senior nurses, 2 physiotherapists and an occupational therapist have also undertaken the role. This presentation explores the impact of physiotherapists undertaking such roles.
Patient experiences of residential orthopaedic rehabilitation programmes at a national specialist centre
Within a national specialist orthopaedic hospital, residential rehabilitation programmes are available for patients with complex orthopaedic needs. Two such rehabilitation programmes, the lower limb (LL) and upper limb (UL) have an emphasis on the rehabilitation of long term (LT) musculoskeletal (MSK) conditions. These programmes are physiotherapy (PT) and occupational therapy (OT) led with access to psychology and psychiatry as appropriate. Both programmes' outcome data has demonstrated their effectiveness. Exploring service user experience was thought to be essential for continuing patient centred care as these services evolve to meet their increased demand.
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.
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.
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.