Scotland

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.

Community Respiratory Team

To demonstrate how a specialist respiratory physiotherapy service placed in the community can prevent unnecessary hospital admissions in patients with COPD.

Grampian Home Oxygen Service

This project is an example of multiprofessional working that provides a safe service for patients whilst making cost savings. 

The new service was established in 2011 to manage Home Oxygen across Grampian. The multi-professional team provides all home oxygen (except for paediatric and cluster headache) based on a clinical need and risk management approach, and liaises with secondary and primary care. The revised service has demonstrated monthly cost improvements of £15 – 20k per month.

A web based prescribing system has been introduced this year by the contractor which offers easy access to updated information relating to individual patients use of oxygen.

Community Respiratory Team

The Community Respiratory Team supports patients living with Chronic Obstructive Pulmonary Disease (COPD) in their own homes.  They work with patients to improve self management of their condition and enable activity and enhanced quality of life when living with this long term condition. 

The project has resulted in shorter hospital stays, due to home based rehabilitation for COPD patients.

Development of Botulinum Toxin-A service in Fife, Scotland

I wanted to highlight the cost savings gained following a review and change of service delivery to children with focal spasticity in a district general hospital.  The purpose of the review and change was to improve the service we provided to children and their families in terms of timeliness on intervention, proximity to home and follow-up with known clinicians. 

Although the data is from 2014, we continue to inject less that 10% of our children under a general anaesthetic compared to 78% in 2009.

This service is led and delivered by a physiotherapist working in an extended role – initially Clinical Specialist, now Advanced Physiotherapy Practitioner with support from Orthopaedic and Neurology consultants.

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