Digital and advancing technology

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.

Recorded Physiotherapy Webinars: Innovative provision of CPD to Physiotherapists working in busy independent sector, MSK clinical environments.

The purpose of this service evaluation was to help better understand the impact and value of running a Recorded Physiotherapy Webinar (RPW) programme to Nuffield Health Physiotherapists.

RPW's are a series of 20-40 minute presentations recorded with both visuals (PowerPoint) and audio (presenter's voice). They are delivered by subject matter experts from across Nuffield Health and aim to promote learning on clinical topics (i.e. ACL rehabilitation, Shoulder red-flags and Cervicogenic headaches).

A total of 14 self-selected RPW's are currently available and can be accessed from anywhere, at any time after the recording via a Learning Management System (LMS).

Using digital technology and user-centred design to develop a physiotherapy self-referral service for back pain

14 million people in England use GP online services. Harnessing digital technology in primary care to develop a physiotherapy self-referral service provides an opportunity to make physiotherapists the first point of contact for patients suffering back pain, whilst enabling service-users to make decisions about how they wish to receive care. A previous self-referral model of telephone and email access yielded low uptake and made inefficient use of administration resources. The aim of this 'proof of concept' project was to explore if a digital physiotherapy self-referral service is safe and acceptable to patients with back pain.

Getting the Know-How: The Feasibility of Delivering a Digital Self-Management Programme for Axial Spondyloarthritis

Despite recommendations by the National Institute for Health and Care Excellence in the management of Axial Spondyloarthritis (AS), adherence to exercise and self-management education is reported to be variable. The Axial Spondyloarthritis Know-How (ASK) self-management programme offers service-users a single attendance exercise and education workshop supported by a self-management digital toolkit. The digital toolkit consists of a short educational film and self-assessment tool prior to attendance and an interactive self-management handbook to support health behaviour change following attendance. The feasibility of delivering a digital self-management programme for adults with AS was explored prior to implementation.

Early detection of post-operative pulmonary complications such as pneumonia using physiotherapy-led lung ultrasound: A case study

Lung ultrasound (LUS) has been shown to have higher diagnostic accuracy (95% sensitivity and 95% specificity) in the detection of pneumonia in patients with respiratory symptoms when compared to chest radiograph (CXR) (49% sensitivity and 92% specificity). Physiotherapists trained in LUS could use this diagnostic technique to monitor patients for pneumonia especially when they begin to show signs of post-operative pulmonary complications (PPC).

The use of a standardised outcome measure within the Musculoskeletal Physiotherapy Services across a Trust in Staffordshire

Musculoskeletal (MSK) physiotherapy teams within Midlands Partnership NHS Foundation Trust (MPFT) historically used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with Chartered Society of Physiotherapy (CSP) recommendations. However, teams used different outcome measures and data collection, inputting and analysis methods varied considerably.

In 2017, the MSK Health Questionnaire (MSK-HQ) was introduced and a data inputting and analysis calculator was developed following a consensus group exercise with the clinical and operational leads of MSK physiotherapy teams to facilitate the implementation of the MSK-HQ.

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