Variation

Referral from primary care musculoskeletal services to Accident and Emergency for suspected cauda equine syndrome

Cauda equine syndrome (CES) is a medical emergency, requiring immediate referral for investigation and early surgical decompression for a favourable outcome (1). Southern Health NHS Foundation Trust (SHFT) musculoskeletal services manage suspected CES with immediate referral to accident and emergency (A&E) at the University of Southampton NHS Trust (UHS) where urgent imaging and surgical decompression can take place.

This evaluation aimed to describe the demographics and clinical features of referred patients, plus summarise the medical management and clinical outcome following A&E examination.

Exploring hospital and physiotherapy length of stay following thoracic surgery

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.

A musculoskeletal single point of referral in primary care

A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013). This was coupled with the implementation of online self-referral for physiotherapy and occupational therapy, where patients were issued advice and exercise within 24 hours. Advice and exercise are issued for patients triaged for physiotherapy through the single point of referral. AHPs are responsible all patient administrative tasks and provide the triaging clinicians. NCHC provide clinical physiotherapy, occupational therapy and orthopaedic triage services. This is contracted to the Norwich and South Norfolk Clinical Commissioning Group and they set key performance indicators for patients being seen. Routine patients to be seen in 28 working days, urgent patients to be seen in 7 days and orthopaedic triage patients to be seen in 14 working days.

Stroke rehabilitation quality improvement plan

Oxford Health NHS Foundation Trust (OHFT) committed to a Stroke Quality Improvement (QI) Project to enhance the quality of rehabilitation for patients on the Oxfordshire Stroke Pathway. Following poor performance in the national indicators Sentinel Stroke National Audit Program (SSNAP) and local Key Performance Indicators (KPIs), the Stroke Quality meeting was initiated by the physiotherapy team to review care and develop a multi-professional improvement plan. Aligning service provision with that recommended in the 2016 Royal College of Physicians National Stroke Guidelines required consolidation of two stroke units, 14 miles apart, into one specialist stroke rehabilitation ward. This abstract outlines key objectives of the QI project, describe progress to date, and evaluates the impact on quality delivery and patient outcomes so far. The objective is to share positive experiences and challenges encountered during the project.

Management of Motor Neurone Disease (MND) clients in their own homes

A service for clients with MND was developed over the past 5 years within VCRS to allow this group of service users easy access to the multidisciplinary team (MDT) throughout the duration of their illness.

We are interested in improving the coordination, communication and care of patients with MND, from diagnosis to end of life, supported by NICE (2016) and MNDA guidelines. We developed individual speciality pathways to encourage prudent healthcare and bridged links in service provision to reduce individual therapy visits, duplication of referrals and assessments and ineffective communication within VCRS and the wider MDT.

The purpose of the service evaluation was to examine if the current service provision actually meets the needs of the service users and their families. We also wanted to identify areas which require further improvement.

We are keen to share this piece of work to demonstrate how existing practices can be altered in order to provide a more prudent and equitable service to this group of clients.

Patient-reported outcome measures (PROM's) following Secondary Care NHS Musculoskeletal Physiotherapy

The aims of this report were:

  • to provide a large, transparent dataset from which other organisations can benchmark clinical outcomes
  • to provide the first documented large-scale musculoskeletal (MSK) physiotherapy outcomes evaluation using the MSK Health Questionnaire (MSK-HQ)
  • to compare clinical outcomes of MSK physiotherapy with NHS England average clinical outcomes associated with surgical procedures.

Communication within pathways of care in hip fracture physiotherapy rehabilitation in England and Wales

Hip fracture is a leading cause of morbidity in people over 60 years old. People experiencing hip fracture require rehabilitation, often from a number of teams, throughout their recovery period. Communication between these different teams poses a challenge to the continuity of care. Communication between professionals delivering care is essential to ensure safe and effective care, continuity of treatment and rehabilitation planning. We used data from the national 'Hip Sprint' audit to understand the flow of information across the hip fracture pathway.

Cauda Equina Syndrome and clinical negligence claims in the UK

Anecdotal evidence from annual reviews of claims against the CSP Professional Liability Insurance scheme suggested that mis-diagnosis of Cauda Equine Syndrome (CES) was being seen more frequently with potential for resultant multi-million awards for damages, defence and claimant costs. This retrospective study sought to assess and quantify all claims notified and specifically claims of alleged failure to diagnose Cauda Equina Syndrome, to inform future risk mitigation.

How do you meet the HCPC and CSP standards and regulations and could you evidence it?

The primary objective for sharing our activity via a Special Interest Report is to illustrate the need for independent measurable compliance of all physiotherapy services against HCPC and CSP Regulations and Standards.

Currently the HCPC re registration focus is on continuous professional development and the Care Quality Commission does not have jurisdiction to regulate standalone physiotherapy services: Therefore, all other regulatory checking is undertaken and reliant on the individual alone. The secondary objective of is to encourage physiotherapists to consider in depth and ensure they appreciate what are they stating, what they agree they are doing when they reregister and sign to state that they comply with all standards and regulations? Could auditing prove that this was the case and, if not, then why are they signing?

Staff engagement in the provision and completion of patient diaries

Patients surviving critical illness are at high risk of developing psychological problems after discharge, with as many as 10% developing symptoms of post-traumatic stress disorder (Wake & Kitchener, 2013), positively correlated with length of intensive care unit (ICU) stay. NICE recommends commencement of rehabilitation as soon as clinically possible in this group. Diaries have been shown to assist patients with fragmented delusional memories and difficulty recollecting their experience, and are hypothesized to work similarly to cognitive behavioural therapy. Factors including lack of awareness, time constraints and the non-compulsory nature has led to inconsistent staff engagement with the patient diary system at Medway Maritime Hospital.This project aimed to increase provision, consistency and overall multidisciplinary team (MDT) engagement with diaries for patients admitted to ICU for over 72 hours.

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