South Central

Measuring Outcomes in MSK: Analysis of Practice and Recommendations for Development

Clinical outcomes are a vital part of understanding quality in healthcare. As part of this, a large Musculoskeletal (MSK) physiotherapy department in Hampshire has measured the clinical outcomes for all of the patients referred into the service. The outcome tool employed was the MSK-HQ (Musculoskeletal Health Questionnaire), a 14 point outcome measure developed to identify and measure the multi-dimensional aspects of musculoskeletal pain. A multi-dimensional tool was chosen to reflect the complexities and co-morbidities that patients with musculoskeletal conditions commonly present with. The MSK-HQ is a tool that can identify the impact that physiotherapy has had on patient health and well-being as opposed to their musculoskeletal complaint in isolation. The aim was to use the data to improve working practices within the service.

Introduction of a day surgery pathway for Unicompartmental Knee Replacement

To disseminate the success of this innovative new pathway, delaying knee flexion, to a wider audience.

The current emphasis within the NHS is to safely reduce the time patients spend in hospital and perform more operations as day surgery or short stay. Our aim was to reduce the length of stay (LOS) for all unicompartmental knee replacements (UKRs) by introducing a new pathway with an innovative rehabilitation protocol, delaying knee flexion. This was to help reduce post-operative pain and speed up mobilisation to give as many patients as possible the opportunity to be managed as day surgery cases.

 

Assessing the impact of training on patient experience

Increased customer satisfaction is associated with reduced complaints, a positive business reputation and often financial return. Within the clinical setting it has more importantly been shown to have a direct correlation with improved clinical outcomes. The therapeutic relationship is one area that can impact on a patients overall experience and their engagement in treatment. This relationship can be improved by making sure that the patients expectations and perceptions are not only acknowledged but clearly understood. A number of physiotherapists identify that they struggle with changing mind-sets of their patients or find that they are unprepared for having those difficult conversations. Supporting physiotherapists to have effective communication skills, the ability to listen and engage and have awareness of the impact of verbal and non verbal cues is essential in improving the patient experience. Training was required to address the gap in skill and knowledge.

Transformation of Therapy Services

To examine the key factors influencing the transformation of Therapy Services within our institution, creating links to sustainable service quality improvements. In 2014 Salisbury NHS Foundation Trust (SFT) carried out a service wide consultation of Physiotherapy and Occupatonal Therapy provision with the aim of transforming Therapy Services. The key outcome from the consultation was the re-organisation of Therapy Services into defined team "clusters" under a single management structure, creating a Head of Therapy Services who reports directly to the Chief Operating Officer and Director of Nursing. The key challenges were addressing the collaborative working within Therapies and across the hospital taking into consideration professional isolation within Directorates, localities, Wiltshire and Wessex Deanary; staffing, recruitment and retention; morale and innovation; and patient flow.

Cultural shift in the value of patient time

Time: Ours to organise, ours to spend and equally ours to waste- but what about when that control is taken. In a culture where our days are filled with loved ones, work and activity, we choose to balance our time across these. However, when you are admitted to an acute hospital, this aspect of choice is often taken away.

As physiotherapists one of our key roles in inpatient care is to improve and regain function to allow our patients to return to their home at their baseline level. By making simple changes- getting patients dressed into day clothes, walking to the toilet and sitting in a chair for meals there can be a clear correlation with the speed of a patient's rehabilitation.

Transnational collaborative digital learning project

Physiotherapy programmes must prepare graduates to live and work in a globally interconnected society. Internationalised learning experiences have the potential to break down ethnocentric worldviews by exposing students to analysis and critique of practice from different cultural perspectives. Such experiences may enable transformative learning by developing the student's ability to shift perspective and reflect critically on how disciplinary practice can change with the social context. Opportunities to study abroad can only be offered to a minority of students. In contrast, digital technology such as discussion forums and video conferencing provide an inclusive platform to make international experiences available to all students on a programme. The aim of this educational project was to engage physiotherapy students in a transnational collaborative group task in order to increase awareness of different international perspectives on clinical practice and healthcare provision and facilitate reflection on their local context.

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