Resource allocation

Oxygen and Non-Invasive Ventilation Pathways in an Adult Cystic Fibrosis Centre

Cystic Fibrosis (CF) is a genetically inherited condition affecting more than 10,000 people in the United Kingdom. A progressive cycle of infection and lung damage occurs. Worsening lung function results in hypoventilation and ultimately leads to respiratory failure that may require supplementary oxygen and/or mechanical support such as Non-Invasive Ventilation (NIV). Guidelines support the use of NIV for nocturnal hypoventilation, hypercapnic respiratory failure and as a bridge to transplant. At the time of development, there were no published guidelines on the use of oxygen therapy in CF and no published pathways on the set up and management of supplementary oxygen or NIV in CF. This special interest report documents the development of separate oxygen and NIV pathways through interdisciplinary working in an adult CF centre.

Objective To develop pathways for supplementary oxygen and the set up and management of NIV in an adult CF centre.

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.

Developing an evidence-based Making Every Contact Count (MECC) model of practice

Population health and prevention is a major priority of the recently formed Greater Manchester Health and Social Care Partnership and is an area in which physiotherapists can make a positive contribution. The Physiotherapy MSK services within the Bury Care Organisation, have successfully developed a MECC model of practice into their service pathways. This quality improvement, uses evidence based behaviour change principles to support patients in making positive lifestyle changes which can impact on their physical and mental health and wellbeing. It also aims to support Trust staff to become more active and promotes health and wellbeing within the wider communities.

Can Emergency Care Therapies Help to Prevent Avoidable Admissions in the Emergency Department?

The Department of Heath estimate that 62% of hospital bed days are occupied by patients over the age of 65. Of these bed days 2.7 million are occupied by patients no longer needing or not requiring acute care in the first place. Of those who are admitted unnecessarily, the Emergency Department (ED) is often where the decision to admit is made. Furthermore, the longer a patient spends in the ED the longer their associated inpatient stay in the hospital will likely be, with the risk of losing up to 5% of their muscle strength per day.

During May and June 2016 the Emergency Care Improvement Programme (ECIP) reviewed Urgent and Emergency Care at Basingstoke and North Hampshire Hospital (BNHH). This was due to reduced ED performance. BNHH did not have an established dedicated Therapy team in ED, despite national evidence and ECIP recommendations. Therapies are well placed in ED to facilitate early patient discharge and help prevent admission of patients who do not require acute hospital care. The project aimed to eliminate avoidable non-medical admissions to inpatient base ward beds in patients over 65 years presenting to ED at BNHH by September 2017.

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.

COPD early discharge service

COPD exacerbations can occur frequently causing lengthy hospital admissions with high re-exacerbation rates. Investment in a COPD EDS is an effective way in improving service and patient outcomes. Other areas may wish to consider adopting this model of care.

The Network Spinal Cord Compression Service

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.

The East Lothian Discharge to Assess Service

Unnecessary delay in discharging patients from hospital is a systemic problem with a rising trend. In 2016/17 there were 532,423 bed days occupied by medically fit patients in Scotland. Over 70% were aged over 75. Current evidence highlights correlation between longer hospital stays and potential harm, resulting in poorer health outcomes, an increase in long-term care needs, poor patient flow and avoidable use of acute resources. Discharge to Assess (D2A) is a national driver and within East Lothian we looked to develop a pathway that supports discharging patients that are clinically fit and appropriate to have their Physiotherapy/Occupational Therapy assessments at home. We aimed to embed D2A as a core East Lothian service and promote a culture of 'ownership' of East Lothian patients throughout their patient journey.

Audit of a dedicated scaphoid pathway

To evaluate the implementation of a service redesign for patients with suspected scaphoid fractures. A scaphoid fracture is a diagnostic and radiographic challenge for clinicians with heterogeneity of assessment and treatment nationally. We propose an advanced physiotherapy led model that reduces both direct and indirect costs to the patient, trust and NHS that is shown to be safe and effective.

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