Physiotherapy Direct Self-Referral to improve patient access to MSk Physiotherapy

Purpose

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.

Approach

In line with our Western Sussex Hospitals Foundation Trust´s patient first approach, Yellow Belt Kaizen style approach was taken to evaluate our service. Using core principles of minimising waste and enhancing effectiveness. Data was collected on the number of patients accessing the service, how they accessed the service, time to being contacted and if they were able to be contacted in the standard time frame. This data was then evaluated and with the use of process mapping, potential problems were identified. Following discussion with the whole team, problems were identified and changes implemented. The data was then collected again to measure the change.

Outcomes

Initially almost 75% of all self referral to physiotherapy were received through a telephone message service. Small numbers of referrals were received by email (1%), written referral form (24%). Of all of these referrals, 18% were unable to be contacted over the telephone within 2 return calls. 87% of these referrals were done leaving a telephone message which did not give enough details to triage correctly. Lack of information lead to increased admin time and waiting time for the patient to be contacted. The process had numerous pathways into the service which resulted in unequal access for patients across the service and also potential for missing serious pathology.

Cost and savings

The current self referral process was widely variable and inefficient for both the service user and the physiotherapy team. There is scope for altering the way people access the service to ensure the correct information is gathered from all people who refer to physiotherapy which will allow them to be triaged appropriately and contacted within a more timely fashion. This will make the service more equitable for all patients as well as cutting down on admin processes and time.

Implications

Changing the physiotherapy access through development of a standardised process for self referral will improve the efficiency and access for the patient. It will allow the physiotherapist to more accurately triage patients prior to calling them back, and fast track patient for urgent appointments if appropriate. Long term, this may be a more time efficient way of managing not only the self referral waiting list but the waiting list for all patients referred to physiotherapy by giving them the option of an initial triage telephone call early on following the referral rather than waiting sometimes well over 10 - 12 weeks before being contacted. This intern could have a positive impact on their outcome in physiotherapy, or prevent the need for physiotherapy treatment all together.

Fund acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2018.