Resource allocation

An evaluation of virtual physiotherapy as an alternative to in-person treatment.

Until recently, virtual physiotherapy services represented the minority of support offered by the private and public healthcare sectors. The Covid-19 outbreak created a sudden need for digital health services to be rolled out more widely.

Ascenti wanted to use its dataset of 27,000+ virtual appointments to see how results for online physiotherapy compared with those for in-clinic care and to gather views from patients and clinicians to enable further improvement.

The Front of House Team: Enabling and Supporting Discharge from the Emergency Department.

There is an increasing strain being placed all across the NHS systems. Emergency Departments up and down the country are being widely criticised for their performance against the national targets. We also have an aging population often with multiple co-morbidities that often present to the emergency department with both health issues and social care issues. The Royal Stoke Emergency department is one of the busiest in the country. In 2018 it had 111,091 attendances. 30,074. It had a higher than national average attendance to admission rate for over the age of 70. An external body wanted to see if creating a new MDT made up of senior decision makers with a background in the care of frail patients could make a difference.

Reducing emergency admissions for primary constipation: a pilot study to cut costs in an acute hospital trust.

Constipation is a common condition that impacts quality of life, often causing psychological distress and incurring considerable healthcare costs in terms of unnecessary emergency admissions due to poor management.

Aintree University Hospital offers one of the only Specialist Physiotherapy led healthy bowel clinics (HBC) in the UK that assess, treat and manage patients presenting with functional bowel problems, including constipation. Patients referred into the service are directed straight to HBC and the majority will never see a medic. The service is run solely by Physiotherapists. We can refer for appropriate tests (transit marker studies, defecating proctograms, anorectal physiology and various blood tests). We independently interpret results and decide on appropriate treatment/management. Our service offers specialist assessment, medication management, lifestyle advice, pelvic floor re-education, Posterior Tibial Nerve Stimulation, rectal irrigation and cognitive behavioural therapy. The majority of our patients are managed conservatively as surgery is rarely an option.

From December 2013 to November 2014, Hospital Episode Statistics (HES) data showed that 301 patients were admitted to Aintree University Hospital with a primary diagnosis of constipation, 216 of these through the Accident and Emergency Department (AED), with an average length of stay of 3.3 days. The HBC Physiotherapists recognised that there should be a more cost-effective, efficient way to manage these patients and proposed a new pathway. The pathway allows patients to manage their symptoms in their own home with support from specialist Physiotherapists, enhancing patient dignity. Assessment identified 5 patients with potential red flag symptoms and allowed appropriate onward referral.

Contributing to service development and enhancing patient care through the establishment of a balance class

The requirement for a balance exercise class was identified whilst working in a musculoskeletal clinic that receives many referrals for patients who attend with balance deficit. We needed a class that would allow patients to improve upon confidence, mobility, functional balance and lower limb strength whilst being fun and augmenting individual Physiotherapy care. This class would also free up the popular assistant rehabilitation clinics.

Assessing the impact of Physiotherapy Training on Emotional Wellbeing.

1 in 4 people experience mental health problems in any given year, 1 in 6 experience work related stress, depression or anxiety. Only 25% of those experiencing emotional distress seek and receive treatment, with many being dependent on the informal support of family or colleagues.

Physiotherapists are also encouraged to investigate Biopsychosocial issues with their patients, through management of persistent pain conditions and may not feel equipped to successfully interpret or manage the information that they receive from the patient. This additional stress can also impact on the Physiotherapists emotional wellbeing and have an impact on patient care.

The aim of this project was to ensure that all Physiotherapists have an appropriate level of emotional literacy so that they are able read/notice the signs of emotional distress in themselves and others and then act appropriately to support themself and others.

The effects of a new Tendo-Achilles Pathway (TAP) on an orthopaedic department.

Achilles tendinopathy is a common pathology that is considered difficult to treat. At a time of austerity in the NHS it is essential to have carefully designed pathways that are monitored in terms of cost and effectiveness. However, a paucity of evidence exists for what the “best value” dedicated “joined up” pathway of care is for this difficult condition. Design, implement and evaluate the impact of a new therapist lead pathway for Tendon- Achilles Pain (TAP).

Priming elderly patients for surgery - the development of a pre-operative service for frail elderly patients

The Peri-operative Review Informing Management of the Elderly (PRIME) Clinic was developed in response to the increasingly frail population undergoing complex major surgery. Due to this, it was recognised that clinicians with advanced skills were required to manage and optimise this patient group pre-operatively, which led to the formation of a multi-disciplinary team consisting of consultant geriatricians, consultant anaesthetists, a senior physiotherapist and a senior occupational therapist. The aim of the team was to optimise patients from a medical, physical and social viewpoint.

The focus of physiotherapy input was to increase physical activity pre-operatively, improve respiratory function and identify falls risks in order to contribute to a reduction in post -op length of stay and improve patient function.

This service evaluation demonstrates the benefit of a highly specialised MDT model with frail elderly elective surgery patients.

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.

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