Patient experience

South Tees Integrated Falls Prevention Strategy

South Tees has had a CCG commissioned falls service since 2007 and has had significant year on year growth in referral rates. Despite this, the team have operated on the same resource and the service had become reactive rather than proactive.

 

Year      Male      Female      Total Referrals
2013   462   861   1323
             
2014   585   1027   1612
             
2015   684   1096   1780
             
2016   678   1047   1725
             
2017   639   1081   1720
             

 

Proposed key outcomes of the review were: A mapping exercise of existing services against NICE guidance was used to identify areas for improvement which created an opportunity to review the current service with a view to develop a system-wide approach to falls prevention.

  • Reduced falls and injuries
  • A region-wide falls pathway
  • Coordinated, individualised risk assessment and interventions
  • Improved partnership working

ICU and Beyond – Establishing a Post ICU Rehabilitation Pathway and Virtual Class

Within our consultant led ICU follow up clinic we recognised that there were an increasing number of patients presenting with on-going physical and psychological problems relating to their stay. Many of these patients reported lack of access to longer term rehabilitation and psychological support.

The purpose was to develop a specialist therapy pathway for patients following an intensive care stay; to improve physical and psychological outcomes, and the overall experience and support for patients and families.

Aspects included working towards;

  • Specialist Supported discharge home.
  • Joint handover of care and on-going support to community teams
  • 3 month review in line with NICE guidance.
  • Provision of MDT rehab class.
  • Capacity to provide hydrotherapy in the future.
  • Development of MDT follow up clinics
  • Psychology support with specific reference to ICU and critical illness

Beyond – Establishing a Virtual Post ICU Rehabilitation Class

 

The COVID-19 pandemic forced us to rethink how we could deliver Post ICU support and ensure rehabilitation needs of those leaving ICU were met.

The redeployment of staff during the first wave allowed us to pilot a virtual Post ICU rehabilitation class.

The Greenwich Pulmonary Rehabilitation Programme: a virtual delivery model & a QI project

The Greenwich Pulmonary Rehabilitation (PR) Service consists of 0.1 WTE team lead, 1.0 WTE band 6 split between 2 part time staff, a fixed term 3 month contract band 5 physiotherapist and 1.0 WTE rehab assistant.

The driver behind the project was to address the issue of the suspension of our face to face supervised PR classes (4 sessions per week at local leisure centres) during the COVID pandemic. With a mounting waiting list and an expectation that we would not be able to return to business as usual, we had to adapt.

Our primary objective was to design a programme that was effective, safe and that patients would enjoy.

A secondary objective alongside the Oxleas QI team was to increase patient completion rates over a 3 year period.

Current completion rates for the Greenwich Pulmonary Rehab programme was low at 40%.

The end point of the project was to be able to confidently offer increased patient choice on how to access PR.

There is an ongoing national challenge to manage patient drop out rates, which are multifactorial in nature. The redesign and delivery of a virtual programme could address problems such as: difficulties travelling to the class, poor weather conditions and psychological challenges where patients feel unable to leave their home to attend.

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 benefits of providing a local serial casting service for children and young people in Powys.

Serial casting is a common conservative intervention for children and young people who are idiopathic toe walkers, or who have cerebral palsy and develop calf muscle contracture. The main aims of serial casting are to improve calf muscle length, walking pattern and efficiency. There is a strong evidence base showing serial casting is effective in improving calf muscle length. Historically in the large and rural county of Powys serial casting has been provided by out-of-county hospitals, making access difficult and involving children, young people and their families travelling long distances. A local physiotherapy-led serial casting service has been piloted within Powys for the last 1 year and 9 months, with capacity to provide treatment in local hospitals and schools as well as client´s homes. A retrospective audit was carried out to assess the benefits and effectiveness of this service.

How a team challenge with teenagers and young adults positively impacts activity levels and engagement.

Current guidelines suggest teenagers should complete 60 minutes of physical activity a day, including strengthening exercises 3 days a week. Research shows that only 20% of teenagers meet these recommendations. Teenage years can be challenging for a variety of reasons; this period is made even harder when you are given a life changing diagnosis of cancer. At the University College London Hospitals Macmillan Cancer Centre we initiated the #JOGLE challenge on our teenage and young adult (TYA) unit. The challenge was to collectively travel the distance from John O'Groats to Land's End - a total of 874 miles - using the equipment in the therapy gym. This service evaluation aimed to look at the impact of this challenge on physical activity levels and engagement with therapy services in TYA with a diagnosis of cancer.

Effects of Aerobic and Strengthening Exercise Combined with Behaviour Change Interventions in Fatigue Management of People with Multiple Sclerosis(pwMS).

Fatigue is one of the more debilitating symptoms as it affects the ability to carry out daily activities. Despite the increasing evidence for the effectiveness of exercise and behavioural change interventions for fatigue management in pwMS, there have been no published critical review that has investigated a combination of exercise and behavioural change interventions. This review aims to investigate the effect of aerobic and strengthening exercise combined with behavioural change interventions in fatigue management in pwMS.

Implementing Prehabilitation in a Tertiary Vascular Centre A Quality Improvement Journey

Prehabilitation is enhancing a patient's functional capacity before surgery, with the aim of improving postoperative outcomes, and should include medical optimization, physical exercise, nutritional and psychological support. Prehabilitation prior to vascular surgery has been recognised in the more recent GIRFT report [2018] .We developed a prehabilitation programme for patients awaiting AAA repair at a tertiary referral vascular centre with a high number of patients undergoing aortic aneurysm surgery

Virtual reality, augmented reality and mirror therapy for musculoskeletal pain

Musculoskeletal conditions are prevalent, often chronic, disorders that impact both physical and mental wellbeing. Exercise therapy is a common physiotherapy treatment, yet adherence to home exercise programmes is low, due in part to pain during exercise. Virtual reality therapy has been shown to be effective at treating acute pain conditions (e.g. burns and dental pain) by disrupting the pain matrix pathways, reducing perception of pain. However, such therapies have not been reviewed in the context of MSK pain. The primary objective of this systematic review was to determine the efficacy of virtual reality (VR) and augmented reality (AR) in the treatment of pain from MSK conditions. The secondary objective was to investigate the impact of VR and AR on disability levels from MSK conditions.

Managing Falls- avoiding the need for conveyance to hospital with early community therapy and specialist paramedic intervention, a winter initiative.

Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.

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