Process changes

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.

Metastatic Spinal Cord Compression - A Retrospective Audit of Current Practice on Medical Oncology and Haematology Wards at GSTT

Metastatic spinal cord compression (MSCC) is an oncological emergency that requires efficient and effective diagnosis, treatment and rehabilitation (NICE 2008).

 

The current MSCC quality standards for adults highlight the need for:

  • Early detection of MSCC through appropriate assessment by MSCC Co-ordinator, spinal surgeon and clinical oncologist, and imaging within 24 hours.
  • Treatment (dexamethasone, radiotherapy, surgery) commencement within 24 hours of confirmed diagnosis
  • Timely rehabilitation and discharge planning with patient and family input

 

The aim of this audit is to:

  • Determine whether the multidisciplinary team (MDT) management of MSCC patients meets national (NICE 2008) and local (KHP, 2016) guidelines at Guys and St Thomas Foundation Trust (GSTT)
  • To identify if and where improvements need to be made against both national and local guidance.
  • To assess components of the care pathway for timeliness, clinical decisions and processes – namely referrals to clinical oncologists, neuro/spinal surgeon, access to timely imaging, prescribing a suitable dexamethasone dose, timely treatment decisions, confirming spinal stability status and referral to rehabilitation services with provision of timely rehabilitation.

Developing programme theories to understand 'First Contact Physiotherapy' in Primary Care: A rapid realist review (FRONTIER)

First Contact Physiotherapy (FCP) is a new primary healthcare model in which a specialist physiotherapist in Musculoskeletal Disorders (MSKDs) located within general practice, undertakes the first patient assessment, diagnosis and management without the requirement for prior GP consultation. It is intended to provide additional capacity and diversify the primary care workforce to meet the high demand for MSKD appointments and the challenges of recruiting and retaining GP staff. Initial audits of the service propose the FCP model may free up GP appointments, reduce secondary care referrals and scan requests, improve patient satisfaction, and produce cost savings. However, there is a lack of robust research evidence, and limited understanding of how best to implement FCP given contextual variation in general practices across the UK. This rapid realist synthesis generated and refined programme theories to develop insight into “What it is about FCP in Primary Care that works, for whom, in what circumstances, how and why?”. This was the second stage of a four-part project exploring the FCP role.

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.

Redesign of NHS Forth Valley´s Community Rehabilitation AHP Single Point of Referral.

NHS Forth Valley Community AHP services have redesigned how they deal with referrals received into their services. Until recently, point of receipt of referrals was purely administrative, with staff signposting to various parts of service that are delivered. Referrals that were deemed “inappropriate” were often lost in the system; there was no cognisance of how these “inappropriate” referrals should be dealt with. There was no understanding of time spent dealing with these queries. We redesigned the service, 'going live' in November 2018, to bring clinical staff into SPR, triaging the referrals received using a Personal Outcomes Approach and have reduced the number of referrals going forwards for intervention at the rehab teams, and increased signposting and self management in the community. This has had a knock on effect to reducing waiting times and enabled a more specific and tailored approach to those requiring rehabilitation in the community.

The Front of House Team: Enabling and Supporting Discharge from the Emergency Department.

There is an increasing strain being placed all across the NHS systems. Emergency Departments up and down the country are being widely criticised for their performance against the national targets. We also have an aging population often with multiple co-morbidities that often present to the emergency department with both health issues and social care issues. The Royal Stoke Emergency department is one of the busiest in the country. In 2018 it had 111,091 attendances. 30,074. It had a higher than national average attendance to admission rate for over the age of 70. An external body wanted to see if creating a new MDT made up of senior decision makers with a background in the care of frail patients could make a difference.

A 3 month prospective audit of physiotherapy referrals to a Community Rehabilitation Team and trial of alternative triage process.

The Community Rehabilitation Team (CRT) provides intermediate care and rehabilitation to individuals unable to leave their homes or who do not meet referral criteria for specialist services. Therapists are generalists whose specialism is managing complexity.

Current practice required all clinical staff (B4 and above) to triage referrals for suitability, and to assign appropriate referrals to immediate action (within 5 days) or a waiting list (up to 18 weeks), according to clinical need. This decision was commonly made directly from information contained within the referral.  

Staff expressed anxiety and frustration with the process, and an inability to affect change or provide support to colleagues. Referrals from traditionally hierarchical superiors could be challenging, especially when declining inappropriate referrals, with concern that this may affect future commissioning.  

This audit of physiotherapy referrals, aimed to classify our caseload through collection of quantitative data, and to trial an alternative triage process.

A Rapid Review of evidence for management of patients that frequently attend Emergency Departments with Chronic Pain.

Frequent attenders (FA) (defined as individuals that attend more than 5 times per annum) of ED have been reported to account for 13% of the total cohort. A common reason for presentation is chronic pain. Guidelines recommended that Frequent Attenders are identified, that case management may assist with involving other services and that multidisciplinary case conferences may aid patient engagement.

  • To critique evidence for case management of patients that frequently attend ED with chronic pain.
  • To utilise the evidence to support an innovative rapid access pathway to a pain rehabilitation service.
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