London

The Greenwich Pulmonary Rehabilitation Programme: a virtual delivery model & a QI project

The Greenwich Pulmonary Rehabilitation (PR) Service consists of 0.1 WTE team lead, 1.0 WTE band 6 split between 2 part time staff, a fixed term 3 month contract band 5 physiotherapist and 1.0 WTE rehab assistant.

The driver behind the project was to address the issue of the suspension of our face to face supervised PR classes (4 sessions per week at local leisure centres) during the COVID pandemic. With a mounting waiting list and an expectation that we would not be able to return to business as usual, we had to adapt.

Our primary objective was to design a programme that was effective, safe and that patients would enjoy.

A secondary objective alongside the Oxleas QI team was to increase patient completion rates over a 3 year period.

Current completion rates for the Greenwich Pulmonary Rehab programme was low at 40%.

The end point of the project was to be able to confidently offer increased patient choice on how to access PR.

There is an ongoing national challenge to manage patient drop out rates, which are multifactorial in nature. The redesign and delivery of a virtual programme could address problems such as: difficulties travelling to the class, poor weather conditions and psychological challenges where patients feel unable to leave their home to attend.

Service evaluation of the Anterior Cruciate Ligament Deficient Induction Clinic (ACLD) and Rehabilitation Class.

Historically, at GSTFT, patients with ACL pathology have been managed in weekly exercise classes. Anecdotally, Physiotherapists felt that they were unable to effectively manage both the post-operative and ACL deficient (ACLD) populations due to high class numbers. After an internal service evaluation and audit, a unique ACLD pathway was established to separate the ACLD population, and better manage both ACL cohorts. This included a specific fortnightly ACLD Induction Clinic and ACLD rehabilitation class.

This data collection aimed to:

  • Evaluate the demand for the ACLD pathway, including the new ACLD rehabilitation class, and analyse patient demographics
  • Ensure the ACLD pathway is utilised correctly, by monitoring patients being referred
  • Start analyzing the data and trends of patient attendance and onward management in the ACLD rehabilitation class and begin early root cause analysis.
  • Commence a systematic review around the quality of pre-operative physiotherapy intervention and how this effects outcomes post-operatively, in order to guide the temporality and content of our ACLD rehabilitation class.

Using digital technology and user-centred design to develop a physiotherapy self-referral service for back pain

14 million people in England use GP online services. Harnessing digital technology in primary care to develop a physiotherapy self-referral service provides an opportunity to make physiotherapists the first point of contact for patients suffering back pain, whilst enabling service-users to make decisions about how they wish to receive care. A previous self-referral model of telephone and email access yielded low uptake and made inefficient use of administration resources. The aim of this 'proof of concept' project was to explore if a digital physiotherapy self-referral service is safe and acceptable to patients with back pain.

Move, Groove Improve Quality Improvement Project

The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.

Getting the Know-How: The Feasibility of Delivering a Digital Self-Management Programme for Axial Spondyloarthritis

Despite recommendations by the National Institute for Health and Care Excellence in the management of Axial Spondyloarthritis (AS), adherence to exercise and self-management education is reported to be variable. The Axial Spondyloarthritis Know-How (ASK) self-management programme offers service-users a single attendance exercise and education workshop supported by a self-management digital toolkit. The digital toolkit consists of a short educational film and self-assessment tool prior to attendance and an interactive self-management handbook to support health behaviour change following attendance. The feasibility of delivering a digital self-management programme for adults with AS was explored prior to implementation.

Use of a protocolised estimated discharge date following hip fracture surgery improves discharge planning and reduces length of stay

Prior to this service development, senior Physiotherapists observed that estimated discharge date setting for hip fracture patients at daily MDT board round was arbitrary and differed significantly based upon which staff members were in attendance that day. A service development was therefore completed to identify an effective and efficient means to use a validated outcome measure to set a protoclised, realistic and evidence-based discharge date on the day of surgery, based upon pre-morbid function.

A specialist fitness for work service: Advanced practice physiotherapist working as a first point of contact practitioner

An advanced practice occupational health physiotherapist introduced a new fitness-for-work service to manage clients with work- related or impacting musculoskeletal disorders. The purpose was to shorten waiting times for clients to access specialist physiotherapy, reduce the number of referrals to GPs, OHPs and OHAs and secondary care, reduce sickness absence and improve productivity, and maintain excellent service user satisfaction.

Impact of early intervention and rehabilitation on functional decline in patients hospitalised for acute heart failure

Acute heart failure (AHF) is the most common cause of admissions for patients aged 65 and over in the UK. The occurrence of functional decline in elderly adults with hospitalisation for acute illness is well established with decline occurring as early as day 2 of admission. With an average length of stay of 18.7 days, patient age of 71.4 years, and 77.1% of patients having at least one other chronic disease, the patients admitted to the Heart Failure Unit at St George's Hospital are high risk for functional decline throughout their stay. Traditionally these patients would not be seen by a physiotherapist until after their intravenous diuretic treatment was completed. The aim was to assess the impact of early and specialist physiotherapy assessment and intervention on functional decline during hospitalisation of patients with AHF.

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