Resource allocation

South Tees Integrated Falls Prevention Strategy

South Tees has had a CCG commissioned falls service since 2007 and has had significant year on year growth in referral rates. Despite this, the team have operated on the same resource and the service had become reactive rather than proactive.

 

Year      Male      Female      Total Referrals
2013   462   861   1323
             
2014   585   1027   1612
             
2015   684   1096   1780
             
2016   678   1047   1725
             
2017   639   1081   1720
             

 

Proposed key outcomes of the review were: A mapping exercise of existing services against NICE guidance was used to identify areas for improvement which created an opportunity to review the current service with a view to develop a system-wide approach to falls prevention.

  • Reduced falls and injuries
  • A region-wide falls pathway
  • Coordinated, individualised risk assessment and interventions
  • Improved partnership working

ICU and Beyond – Establishing a Post ICU Rehabilitation Pathway and Virtual Class

Within our consultant led ICU follow up clinic we recognised that there were an increasing number of patients presenting with on-going physical and psychological problems relating to their stay. Many of these patients reported lack of access to longer term rehabilitation and psychological support.

The purpose was to develop a specialist therapy pathway for patients following an intensive care stay; to improve physical and psychological outcomes, and the overall experience and support for patients and families.

Aspects included working towards;

  • Specialist Supported discharge home.
  • Joint handover of care and on-going support to community teams
  • 3 month review in line with NICE guidance.
  • Provision of MDT rehab class.
  • Capacity to provide hydrotherapy in the future.
  • Development of MDT follow up clinics
  • Psychology support with specific reference to ICU and critical illness

Beyond – Establishing a Virtual Post ICU Rehabilitation Class

 

The COVID-19 pandemic forced us to rethink how we could deliver Post ICU support and ensure rehabilitation needs of those leaving ICU were met.

The redeployment of staff during the first wave allowed us to pilot a virtual Post ICU rehabilitation class.

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.

An evaluation of virtual physiotherapy as an alternative to in-person treatment.

Until recently, virtual physiotherapy services represented the minority of support offered by the private and public healthcare sectors. The Covid-19 outbreak created a sudden need for digital health services to be rolled out more widely.

Ascenti wanted to use its dataset of 27,000+ virtual appointments to see how results for online physiotherapy compared with those for in-clinic care and to gather views from patients and clinicians to enable further improvement.

Paediatric Anterior Cruciate Ligament (ACL) reconstruction rehabilitation pathway

Decreased activity levels as well as earlier sport specialism in paediatric populations are leading to an increase in number of patients with traumatic ACL rupture. ACL repairs are preferred due to evidence of adverse long term outcomes with conservative management. Therefore, the demand for ACL reconstruction rehabilitation is increasing. Additionally, high re-injury rate (29%) in adolescents post reconstruction surgery has been documented. In order to provide optimal evidence based rehabilitation and prevent re-injury in these patients the ACL Pathway was created. This service evaluation investigates the effectiveness of the pathway since it was implemented 18 months ago.

Testing models of Integrated working in acute hospital wards to scope models of healthcare for the future.

With a national picture of a shortfall of qualified nurses and continued NHS cost improvements, Sheffield teaching hospitals wanted to test using Integrated wards to scope new models of healthcare for the future. Aiming to be cost efficient, whilst delivering high quality care to patients and creating an improved working environment for staff. The project looked for ways to share skills and work more closely between the therapy and nursing professions, to avoid duplication, deliver the care patients need in a timely way and optimise time for each Profession to give their expertise to the patients who need it.

The Importance of Leadership in Community Physiotherapy

Supporting Community Rehabilitation is a core priority for the Chartered Society of Physiotherapy. With increasing national pressures to move care into the community and out of hospital, we know there is a significant challenge ahead. We hear anecdotally that community physiotherapy services are under resourced, carry long waiting lists and are considered unattractive roles by many working in other specialities. Many services are blighted by issues of recruitment and retention. We know we have an ageing population and rising numbers of people have multiple long term conditions. The rehabilitation needs associated with those conditions is often provided by physiotherapists working in the community. We wanted to understand the realities of working community physiotherapy, the models of care that have been used to support service improvements and to design a package to support members in practice.

Managing Falls- avoiding the need for conveyance to hospital with early community therapy and specialist paramedic intervention, a winter initiative.

Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.

The value of a Consultant Physiotherapist within a Primary Care Musculoskeletal Interface Services: Part of the Spinal Multi-Disciplinary Team

Patients with spinal pathologies can range from simple mechanical low back pain to complex pathology requiring urgent medical or surgical intervention. The national low back pain pathway recommends the use of 'triage and treat' practitioners working at an advanced level to manage the majority of these patients, yet the skill mix of such services varies throughout the country resulting in delays for complex patients and unnecessary waits for surgical services for others who could be adequately managed conservatively.

Increasing long-term participation in sports based activities in children and young people with acquired brain injury.

Participation in sports can play a key role in a child’s quality of life, development and learning (Willis, 2018). Children and young people (CYP) with acquired brain injury (ABI) face significant barriers in accessing sporting and leisure activities.  This reduces the likelihood of participation in regular sporting and leisure activities (Anaby,2018),  both in the recovery period and the later stages (Willis, 2018).

This is a quality improvement project that explores the implementation of a sports based group in a neurorehabilitation centre for CYP with ABI.

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