Workforce planning and development

The Impact of a Physiotherapist in the Role of Clinical Matron within a Stroke 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.

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.

Rheumatology Triage and Assessment by Advanced Practitioner Physiotherapists

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

The Network Spinal Cord Compression Service

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.

Physiotherapy assistants in the musculoskeletal outpatients setting

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Telephone-based triage and diagnostic accuracy of spinal pathologies

Advanced Level Physiotherapy (ALP) is a term used to describe a level of practice for a physiotherapist to be working at. It includes utilising a combination of advanced skills, knowledge and clinical reasoning to successfully and safely manage patients, recognising where a clinical presentation is outside an individual's scope, and taking appropriate action. Utilising advanced clinical reasoning and making appropriate radiology referrals enables physiotherapists to exclude serious pathology and determine the appropriate pathway for a patient. Being able to safely triage and direct patients to conservative management or escalate to an orthopaedic review where suitable is the cornerstone of a clinically-effective service, and highlights the benefits of having experienced physiotherapists on hand to guide patients appropriately. Many studies have looked at whether the diagnostic accuracy of physiotherapists is comparable to orthopaedic consultants, but the diagnostic accuracy of a telephone based ALP triage service has not previously been investigated. The aim of this study was to audit the diagnostic accuracy of radiology investigations performed for spinal pain (cervical, thoracic, lumbar and sacroiliac) by a telephone based ALP triage service.

Early identification of respiratory impairment in motor neurone disease

Respiratory function significantly predicts both survival and quality of life in people with Motor Neurone Disease (MND). Early referral to specialist respiratory services at the onset of symptoms is vital to facilitate decisions regarding respiratory management. Effective management of respiratory symptoms is likely to have a positive impact on the quality of life of the person with MND. Objective measures of respiratory function allow clinicians and patients to self-monitor respiratory symptoms at home. A challenge of working within a multi-disciplinary (MDT) community neurological therapy team was the lack of easy to use, accessible, accurate objective measures of respiratory function. We describe the development of the team's MND respiratory assessment, which aimed to improve early identification of people with respiratory impairment. A further aim was to improve the referral pathway between the community team and its local sleep and ventilation service.

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