To evaluate whether service improvements could be made to our community physiotherapy service through clinical streaming of patient referrals using underlying principles complexity science to consistently deploy the most appropriate member of the physiotherapy team to meet the needs of patients and improve the effectiveness of our service.
An audit on length of stay (LOS) for total knee replacement (TKR) patients following surgery highlighted that a number of patients were exceeding their predicted date of discharge (PDD), many due to not achieving traditional physiotherapy goals (90⁰ flexion, < 5 ° extension lack and good quadriceps function), despite being safely mobile and medically fit. This exposes patients to risk of harm due to prolonged stay within an acute hospital environment as well as inefficient utilisation of an in-patient bed. A Physiotherapy Supported Discharge Service (PSDS) had previously been piloted for six months. Phase 2 consisted of permanent service resign, continuing the PSDS and service evaluation.
Historically, provision of MSK Ultrasound diagnostics has been via a referral to Radiology. However, there is increasing evidence that assessment, investigation and initiating treatment at the initial appointment is shown to be cost-effective, increasing patient satisfaction. Utilising this approach also reduces repeated hospital visits for further diagnostics and appointment times for results. The aim of using Point of Care (POC) ultrasound is to enhance the patient experience through instant access to diagnosis, timely implementation of most appropriate clinical pathway and achievement of the optimal outcome in the shortest possible time.
This study aims to investigate the benefits of point of care (POC) and schedule ultrasound clinics using a proof of concepts approach in the orthopaedic setting.
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.
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 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.
Recent scandals relating to care failings within the NHS have led the UK government to recommend that providers examine the recruitment methods for healthcare professional education programmes and initiate better screening of those entering the professions (Francis, 2013). The School of Healthcare Sciences at Cardiff University has committed to interviewing all applicants prior to enrolment and have instigated a multiple mini-interview (MMI) structure to do so.
In MMIs candidates have many opportunities to make a first impression, meeting different assessors at each station, suggesting the process is fairer and more consistent when compared to traditional panel interviews (Eva et al, 2004). However, if MMIs are designed to select for specific attributes and personalities, do they result in a homogenous student population and thus reduce the diversity of experiences, thoughts and behaviours within? Is the process which is thought to be 'fair' actually fraught with bias?
This project aimed to investigate bias within the MMI structure for Physiotherapy recruitment at Cardiff University. It considers the design and scoring of interview stations and their inclusivity, through the monitoring of performance at each station by applicants with differing characteristics.
This paper reports on the findings of the first phase of a service improvement project that used the Ophelia approach developed by Deakin University, Australia to evaluate the health literacy (HL) needs of adults attending outpatients musculoskeletal (MSK) physiotherapy.
Little is known of the impact that the social determinates of health have on the health literacy needs of patients presenting with musculoskeletal pathologies so the relationship with demographic data, including the Welsh Index of Multiple Deprivation (WIMD) was explored.
The aim of the first phase was to profile adults' health literacy attending outpatient MSK physiotherapy. Objectives included:
- to evaluate adults across nine domains of health literacy
- to establish whether there is a relationship with measures of deprivation. The results of profiling will inform the development of specific health literacy interventions and resources for the local population in future phases.
Following total knee replacement (TKR), patients are not only required to be functionally and medically safe for discharge but also achieve set exercise goals before being allowed home. These set exercise goals are: · 90 degree knee flexion. · A straight leg raise with < 5 degree quadriceps lag. · Inner range quadriceps with < 5 degree quadriceps lag. These goals are set by the operating Consultants. A recent audit on length of stay (LOS) highlighted that out of 38 patients, 32 (84%) had exceeded their predicted date of discharge (PDD). Of these 32 patients, 19 (59%) had exceeded their PDD as a result of not achieving their exercise goals by this time, despite being deemed functionally and medically safe. Further audit over a 12 week period highlighted an additional 38 TKR patients remaining in hospital after being deemed functionally and medically safe in order to achieve the set exercise goals. This equated to 65 additional bed days over the 12 week period, approximately 5 additional bed days per week. With a standard overnight stay costing £400 per night, this equated to £26,000 over the 12 week period and therefore potentially £104,000 a year. It was suggested that providing a physiotherapy service to allow TKR patients to go home once functionally and medically safe but without achieving their exercise goals could facilitate discharge for these patients without compromising the quality of their care or outcomes