Innovations

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Innovations - quality assured physiotherapy initiatives

Our quality assured examples of successful initiatives aim to promote physiotherapy as an innovative and cost effective approach to improving patient pathways and promoting public health. We welcome examples and case studies from all aspects of physiotherapy practice, research, education, and service delivery.

You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. 

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Medicines optimisation for the treatment of spasticity and neuropathic pain led by a Physiotherapist Independent Prescriber

The purpose of this project was to improve medicines optimisation for the management of patients with spasticity or neuropathic pain who attended multidisciplinary specialist neuro outpatient clinics at West Midlands Rehabilitation Centre. The secondary purpose was to identify how much input was required to optimise medication after a change in medication was advised and if this input could be adequately carried out by a Physiotherapist Independent Prescriber.

Historically the Consultant (prescriber) would review and make changes as required to a patient’s medication for managing their spasticity and neuropathic pain.  Patients could contact in case of concerns, however, there was usually no medication follow up initiated by the Consultant between clinic appointments. This was due to limitations on Consultant capacity. Time periods between clinic appointments for each patient could be between 3-12 months depending on the request of the Consultant. This meant that if there were issues with obtaining or taking the medication and the patient did not initiate contact, the issue would not be addressed until the patient returned to clinic.

NICE provides guidance that the prescriber should review the patient with regards to their medication after starting or altering a medication within a timely period. This is important as it ensures that patients receive the right choice of medication for them, at the right dose and right time to benefit their health.

Medication reviews following a face to face appointment do not necessitate a face to face appointment and telephone reviews can be completely adequate.  This is because patient achievement of goals of treatment with medication is primarily identified through subjective assessment. The standard in this project was set that all patients who required a medication change in clinic would be reviewed, on time via telephone consultation(s). The time at which the patient would be need to be reviewed would be dependent on the time period in which the prescriber advised the medication change to occur over.

Data analysis on the role of the Independent Prescriber in Physiotherapy led spasticity clinics

The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction.  The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.

The Impact of a Physiotherapist in the Role of Clinical Matron within a Stroke Service

To explore the impact of putting senior clinicians at the bedside with clinical expertise in their speciality to improve quality of patient care. This role was introduced at Hampshire Hospitals Foundation Trust (HHFT) in 2016, whilst mainly undertaken by senior nurses, 2 physiotherapists and an occupational therapist have also undertaken the role. This presentation explores the impact of physiotherapists undertaking such roles.

A physiotherapy led clinic in the Emergency Department for suspected scaphoid fractures

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.

Trial of diagnostic ultrasound in the orthopaedic setting

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.

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.

Implementing an occupational healthcare model

Approximately 20,000 sick days (1500 staff members) at St. George's University Hospitals NHS Trust (SGUHT) are due to musculoskeletal issues. This costs the trust approximately £3.4 million per year. Despite this it is the only trust within inner London that, currently, does not have a physiotherapy service within their Occupational Health (OH) offering. The argument for delivering the service is clear, supported by previous research, service evaluations and local data analysis.

Patient satisfaction and outcomes of MSK pain patients accessing Advanced Physiotherapy Practitioner in primary care

The service objectives are to:

  1. Reduce workload of GPs
  2. Provide assessment and self-management
  3. Provide high quality care and a good patient experience to patients with MSK problems
  4. Support patients to remain in/return to work
  5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.