Variation

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.

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

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.

The use of electrical stimulation in the treatment of adult traumatic brachial plexus injuries

Traditionally the Electrical Stimulation (ES) of muscles was a frequently used adjunct for rehabilitation following nerve injury. More recently its use has been in decline. An international collaborative group of therapists with a special interest in Traumatic Brachial Plexus Injuries (TBPI) was formed in 2017. One of the objectives of the group is to assess and improve the evidence base surrounding the rehabilitation of TBPI. Disparity within the group with regards to the use of ES highlighted the need to explore current practice and the reasons for variability in use.

A physiotherapy led clinic in the Emergency Department for suspected scaphoid fractures

The purpose of the service evaluation was to assess the management of suspected scaphoid fractures in a new physiotherapy-led scaphoid clinic and to compare the standard of care for suspected scaphoid fractures for patients who were previously being managed by the ED doctors in an ED Consultant clinic. Historically, the suspected scaphoid fractures were being managed in the ED Consultant clinic. After a period of observation and supervised practice, the Advanced Physiotherapy Practitioner implemented a new scaphoid clinic in Dec 2015. A revised pathway for secondary imaging and management was discussed an agreed with the ED Consultants and Consultant Radiologists.

Standardising physiotherapy provision for patients with haemophilia

Haemophilia is an inherited bleeding disorder characterized by recurrent bleeding into muscles and joints with longer term effects including synovial hypertrophy and destruction of the articular cartilage. The national service specification for haemophilia states that 'specialist physiotherapists trained in line with the Haemophilia Chartered Physiotherapists Association' (HCPA) should be a part of haemophilia services. Despite this, there is huge variability in funded, protected hours for physiotherapists working in this area across the UK. Implications of inadequate physiotherapy provision for these patients is far reaching, including increased bleeds and subsequent joint damage for patients, increased factor costs, and increased pressure on haemophilia doctors. One of the key objectives of the HCPA is to establish core principles of care, determine the levels of service provision and improve physiotherapy services for people with haemophilia in the UK.

Rheumatology Triage and Assessment by Advanced Practitioner Physiotherapists

In May 2016 rheumatology referrals were outstripping service capacity, leading to increasing waiting times for new patients. Following a review of new patient referrals the team identified that a significant proportion of referrals, though being appropriately referred to rheumatology, were for non-inflammatory conditions. Recognising the changing landscape of the NHS and the emphasis to look at different ways of working we put forward a proposal to pilot a rheumatology advanced practitioner physiotherapist (APP) with the following aims: -

  • Improve the triage process
  • Streamline the pathway for new patients with non-inflammatory conditions
  • Reduce waiting times
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