Patient outcomes

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.

Integrating Physiotherapy into an Adult Social Care Occupational Therapy service.

The Occupational Therapy (OT) service at Leicester City Council (LCC) faced some difficulties when they were working with a person who required Physiotherapy (PT) input in the community. Namely the long waitlist for input and an inability to establish a person’s baseline level of mobility when this was needed before recommending care packages, equipment or adaptations. The impacts on LCC were an increased need for formal care, equipment and adaptations as well as increases in OT staff’s workloads and/or delays in picking up new cases. Additionally, the cost to the person is highlighted as delays in accessing PT input can lead to further deterioration in their abilities (dependence) and/or the need to wait longer for equipment/ adaptations which may put them at risk.

Goal-Directed and person-centred Rehabilitation for spasticity post-stroke and brain injury.

Stroke and brain injury-survivors have difficulty controlling muscles and in many cases, 'tightness' of muscles called spasticity. Spasticity is often painful, akin to muscle-cramp. It can limit mobility and independence and cause distressing complications of contractures, skin breakdown and pressure sores.

The aim of this work was to development a preliminary model 'goal-Directed and person-centred Rehabilitation (Direct-Rehab)', to link clinical decision making for patient centred treatment, with the goals and process of treatment. This requires a focus on linking physical rehabilitation treatments (often in combination with pharmacological treatments such as botulinum toxin) to person-centred goals.

The role of Men's Sheds in promoting the physical and mental well-being of older men.

The active and healthy ageing agenda challenges the perception that old age is a negative experience and recognises the positive contributions that older adults can make to their communities. However, successful ageing in place requires community-based support for older adults that facilitates social participation, independence and being active. Older men are less likely to join community groups where they can develop social ties and less gender specific support services are available for them.

Men's Sheds (MiS) is an initiative that aims to mitigate this by fostering the building of social networks between older men by providing social space for them to meet and undertake physical activities such as woodwork or metalwork.

The purpose of this research is to investigate the impact of MiS on the physical health and mental well-being of the attendees.

Description of performance and functional trajectory of acute oncology inpatients at a London tertiary centre.

Advances in cancer care and its treatment mean that people living with a cancer diagnosis are living longer but not necessarily living well. It is reported that cancer patients present with multifaceted symptom burden that often impacts on physical performance.

At present exemplar models of cancer rehabilitation exist across the UK along with tumour and symptoms rehabilitation guidance in the form of NCAT Rehabilitation Pathways (National Cancer Action Team, Macmillian Cancer Support 2013). Implementation of these rehabilitation pathways into the inpatient setting can be challenging due to the multifactorial nature and interplay of symptoms cancer patients present with and the resources available.

Our local study primarily aimed to understand the functional trajectory of our acute inpatient population in order to determine how the cancer rehabilitation of the acute population can be optimised in future proposed work.

Key study aims:

  • To describe the acute inpatient oncology population
  • To describe the performance and functional trajectory of the acute inpatient oncology population
  • To feed into a wider project supported by fit for the future looking at “how do we optimise rehabilitation in acute oncology inpatients”

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.
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