Workforce planning and development

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.

NICE Guidance and Quality Standard Assurance Evaluation: a process redesign to improve effectiveness and efficiency.

NICE assurances processes which evaluate local clinical practice and services against NICE guidance, quality standards and interventions are important clinical effectiveness and quality improvement strategies. Trusts are required to undertake a local NICE assurance process and results of evaluations are reported centrally.

The aim of this project was to develop a more efficient, robust and meaningful approach to our NICE assurance process across our complex, multi-professional clinical division. Our division has over 30 different clinical services in acute and community settings across East Sussex. The objective was to create a single, unified and responsive approach across all our uni- and multi-professional services.

Reducing emergency admissions for primary constipation: a pilot study to cut costs in an acute hospital trust.

Constipation is a common condition that impacts quality of life, often causing psychological distress and incurring considerable healthcare costs in terms of unnecessary emergency admissions due to poor management.

Aintree University Hospital offers one of the only Specialist Physiotherapy led healthy bowel clinics (HBC) in the UK that assess, treat and manage patients presenting with functional bowel problems, including constipation. Patients referred into the service are directed straight to HBC and the majority will never see a medic. The service is run solely by Physiotherapists. We can refer for appropriate tests (transit marker studies, defecating proctograms, anorectal physiology and various blood tests). We independently interpret results and decide on appropriate treatment/management. Our service offers specialist assessment, medication management, lifestyle advice, pelvic floor re-education, Posterior Tibial Nerve Stimulation, rectal irrigation and cognitive behavioural therapy. The majority of our patients are managed conservatively as surgery is rarely an option.

From December 2013 to November 2014, Hospital Episode Statistics (HES) data showed that 301 patients were admitted to Aintree University Hospital with a primary diagnosis of constipation, 216 of these through the Accident and Emergency Department (AED), with an average length of stay of 3.3 days. The HBC Physiotherapists recognised that there should be a more cost-effective, efficient way to manage these patients and proposed a new pathway. The pathway allows patients to manage their symptoms in their own home with support from specialist Physiotherapists, enhancing patient dignity. Assessment identified 5 patients with potential red flag symptoms and allowed appropriate onward referral.

A project evaluating integration of a physiotherapy assistant practitioner into consultant led falls clinic and the effect on referrals.

72% of Community Rehabilitation Team (CRT) referrals are generated outside of our NHS Trust. External referrers have no access to our electronic records, and the complexity of local therapy services mean that duplicate and repeat referrals are common. Previous work also highlighted the 'yes' effect of individuals attending outpatient clinics, who consented to onward CRT referrals, but subsequently declined intervention.

This 'Plan, Do, Study, Act' (PDSA) project aimed to evaluate a new way of working to manage both issues. The project was undertaken in a neighbouring trust Consultant Led Falls Clinic (CLFC), identified as high referrer to our service.

Replacing a Retiring Consultant Rheumatologist with an Appropriately Skilled Consultant Physiotherapist.

The role of the Advanced Practice Physiotherapist (APP) has been well established in our Rheumatology team for more than 10 years. However, following the semi-retirement of one of the medical consultants there has been an option to pilot Consultant-level Physiotherapy input to the Rheumatology team. This process of using allied health professionals to replace medics has been called “Practitioner Substitution” and is seen as an important part of improving care and patient outcomes whilst delivering the efficiencies the NHS needs. The aims of the pilot Consultant post were: to independently manage and streamline the pathway for the non-inflammatory / pain service in Rheumatology, to reduce wait times and to ensure a more inflammatory-heavy caseload for the remaining Rheumatology medical team.

Role-Emerging Physiotherapy Placements in Dementia Care; a Service Improvement.

Physiotherapy role-emerging placements can occur at sites where there is minimal or no physiotherapy service or established physiotherapy role. Lack of physiotherapy provision has been identified in care home settings, and this lack impacts on the quality of care in managing complex physical and mental health conditions such as dementia.

The Care Home Liaison team uses a multi-disciplinary model to develop interventions to support individuals living with dementia to have positive lived experiences of the care home setting. However, where physical health is a component of the individual's mental well-being, the team is limited to over-stretched community physiotherapy services.

This gap in knowledge and practice highlights the unique role physiotherapy could offer in managing such a complex client group. Physiotherapists working in dementia care offer an important role in the management of physical conditions, together with promoting and maintaining mobility and function. This has a positive impact on the behavioural and psychological symptoms of dementia and so reduces the use of pharmacological interventions.

Role-emerging placements can highlight the value and impact physiotherapy has, and allows students to develop skills and experience in increasingly diverse, complex and evolving workplaces.

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