North West

Patients accessing Physiotherapy in Blackburn demonstrate multiple co-morbidities, physical and biopsychosocial issues. This unique, cost-effective, collaborative service redesign addresses the specific co-existing health issues and behaviours associated with MSK conditions in Blackburn and offers a cost-effective, high quality solution to empower and support the MSK population to better manage their own health and well-being in alignment with Public Health England priorities.

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.

To use Quality Improvement (QI) science, for the implementation of a patient self referral initiative “go2physio”. The initiative took place over 12 months.

The First Contact Physiotherapy Service was established as a pilot within the musculoskeletal service in January 2019.  This patient evaluation project was undertaken in order to:

• Ensure the service was meeting the needs of the patients accessing it.
• Capture patient experience.

The purpose of this project was to evaluate the role of the nursing HCA as part of the critical care multi professional rehabilitation team, with the express purpose of boosting rehabilitation during periods when there was no therapies services, and to fully embed the ethos of 24/7 hour rehabilitation into the critical care culture.  

The role of the Advanced Practice Physiotherapist (APP) has been well established in our Rheumatology team for more than 10 years. However, following the semi-retirement of one of the medical consultants there has been an option to pilot Consultant-level Physiotherapy input to the Rheumatology team. This process of using allied health professionals to replace medics has been called “Practitioner Substitution” and is seen as an important part of improving care and patient outcomes whilst delivering the efficiencies the NHS needs. The aims of the pilot Consultant post were: to independently manage and streamline the pathway for the non-inflammatory / pain service in Rheumatology, to reduce wait times and to ensure a more inflammatory-heavy caseload for the remaining Rheumatology medical team.

Lung ultrasound (LUS) has been shown to have higher diagnostic accuracy (95% sensitivity and 95% specificity) in the detection of pneumonia in patients with respiratory symptoms when compared to chest radiograph (CXR) (49% sensitivity and 92% specificity). Physiotherapists trained in LUS could use this diagnostic technique to monitor patients for pneumonia especially when they begin to show signs of post-operative pulmonary complications (PPC).

Adults and children diagnosed with cystic fibrosis (CF) are regularly exposed to ionising radiation, from chest radiographs (CXR) and computed tomography (CT). This poses an issue as life expectancy has increased into the fifth decade of life.

Lung ultrasound (LUS) has the ability to assess many lung pathologies experienced in CF with accuracy close to CT but without the exposure to ionising radiation. The purpose of this review is to explore the literature to establish if LUS is being used to aid the management of patients with CF.

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.

It was recognised that the neuro-rehabilitation unit had a length of stay above the national average of 80 days. A new multidisciplinary goal planning process was implemented on the unit with the following aims; reduce length of stay to the national average; reduce the waiting list to 1 week; to consistently achieve greater than 70% patient and family/carer satisfaction.  The impact on the FIM/FAM outcome measure was monitored to ensure there were no adverse effects on patient outcome as a result of implementing the new process.