Demand, capacity and flow

A review of an innovative digital group therapy breathing & energy management programme designed to reduce symptoms of Long COVID.

The purpose of this programme was to implement a service for patients suffering with symptoms of Long COVID (symptoms for longer than 12 weeks post COVID). 

The two most common symptoms of Long COVID are breathlessness and fatigue1. Two physiotherapists who are committee members of the special interest groups Breathing Pattern Disorders (BPD) and ‘Physio for ME’ ( fatigue management) collaborated with RespiriCare (independent company consisting of specialist respiratory physiotherapists) and 3 patients suffering with Long COVID to create a live, virtual 6-week breathing & energy management programme.

The home-based educational programme encourages good quality rest, energy management, sleep management, re-establishing efficient breathing and optimal nutrition and hydration which are essential for the recovery from COVID2.

Long Covid Rehabilitation – How we responded to the needs of people with Long Covid.

As the Covid-19 pandemic unfolded our team rapidly coalesced to anticipate, study and respond to the problem of Long Covid (LC). We now know LC is a syndrome of persistent physical, cognitive and/or psychological symptoms that continue after acute COVID-19 illness. There are an estimated one million individuals in the UK who are struggling with these symptoms.

Our clinical team highlighted the long-term effect of Middle East respiratory syndrome (MERS) and Severe acute respiratory syndrome (SARS) and thereby warned about problems to come with COVID-19. We then studied and published on the longer term effects of COVID-19. Using this data, the emerging wider literature and the experiences of our patients, we established that LC was affecting many adults who were typically young or in middle age, previously healthy and in demanding roles such as caring or employment.

The high prevalence and severity of impairment being experienced makes this an urgent health and economic problem, which we then developed an assessment and treatment service to respond to those needs.

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.

Integrating Physiotherapy into an Adult Social Care Occupational Therapy service.

The Occupational Therapy (OT) service at Leicester City Council (LCC) faced some difficulties when they were working with a person who required Physiotherapy (PT) input in the community. Namely the long waitlist for input and an inability to establish a person’s baseline level of mobility when this was needed before recommending care packages, equipment or adaptations. The impacts on LCC were an increased need for formal care, equipment and adaptations as well as increases in OT staff’s workloads and/or delays in picking up new cases. Additionally, the cost to the person is highlighted as delays in accessing PT input can lead to further deterioration in their abilities (dependence) and/or the need to wait longer for equipment/ adaptations which may put them at risk.

Testing models of Integrated working in acute hospital wards to scope models of healthcare for the future.

With a national picture of a shortfall of qualified nurses and continued NHS cost improvements, Sheffield teaching hospitals wanted to test using Integrated wards to scope new models of healthcare for the future. Aiming to be cost efficient, whilst delivering high quality care to patients and creating an improved working environment for staff. The project looked for ways to share skills and work more closely between the therapy and nursing professions, to avoid duplication, deliver the care patients need in a timely way and optimise time for each Profession to give their expertise to the patients who need it.

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

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.

The value of a Consultant Physiotherapist within a Primary Care Musculoskeletal Interface Services: Part of the Spinal Multi-Disciplinary Team

Patients with spinal pathologies can range from simple mechanical low back pain to complex pathology requiring urgent medical or surgical intervention. The national low back pain pathway recommends the use of 'triage and treat' practitioners working at an advanced level to manage the majority of these patients, yet the skill mix of such services varies throughout the country resulting in delays for complex patients and unnecessary waits for surgical services for others who could be adequately managed conservatively.

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