South West

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.

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 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.

The effectiveness of non-pharmacological interventions to treat orthostatic hypotension in people with stroke.

The prevalence of Orthostatic Hypotension (OH) post-stroke is high. OH can be a barrier to stroke rehabilitation, where mobilisation (out-of-bed activities such as sitting, standing and walking) is recommended at the earliest opportunity. The potential risk of harm with OH must be acknowledged and addressed since, in acute and sub-acute stroke, OH has the potential to cause further brain damage due to cerebral hypo-perfusion. This may result in increased disability and mortality. However, current guidelines for the management of people with stroke do not provide guidance on assessing and treating OH.

People with stroke are more likely to have multi-morbidity, thus are at greater risk of polypharmacy. Therefore, identifying non-pharmacological interventions to treat OH is of importance both to minimise polypharmacy, and optimise safe participation in early rehabilitation.

The aim of this systematic review was to summarise the best available evidence regarding the effectiveness of non-pharmacological interventions to treat OH in people with stroke.

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.

Oxygen and Non-Invasive Ventilation Pathways in an Adult Cystic Fibrosis Centre

Cystic Fibrosis (CF) is a genetically inherited condition affecting more than 10,000 people in the United Kingdom. A progressive cycle of infection and lung damage occurs. Worsening lung function results in hypoventilation and ultimately leads to respiratory failure that may require supplementary oxygen and/or mechanical support such as Non-Invasive Ventilation (NIV). Guidelines support the use of NIV for nocturnal hypoventilation, hypercapnic respiratory failure and as a bridge to transplant. At the time of development, there were no published guidelines on the use of oxygen therapy in CF and no published pathways on the set up and management of supplementary oxygen or NIV in CF. This special interest report documents the development of separate oxygen and NIV pathways through interdisciplinary working in an adult CF centre.

Objective To develop pathways for supplementary oxygen and the set up and management of NIV in an adult CF centre.

Patients with fibromyalgia attending primary care based education seminars and workshops

To ascertain patient feedback following their attendance at education seminars “Understanding Fibromyalgia”, “The role of medications in the management of Fibromyalgia” and a 'Moving forwards workshop' for people with a diagnosis of Fibromyalgia Syndrome (FMS). This is a change from usual practice where patients were seen in specialist secondary care by a member of the medical team. Education and exercise are now prioritised as first-line interventions.

Therapy led Stroke Early Supported Discharge: outcomes in mild to moderate stroke survivors

The Stroke Early Supported Discharge (ESD) service enables accelerated discharge to service users providing seven days a week specialist rehabilitation and social support in the community to mild and moderately impaired stroke survivors. Service provision is focused around time specific goals and will consider the needs and ability of their carers. The main focus is to save bed days and improve patient outcomes and goals in the community setting.

The main aims and objectives is to demonstrate the outcomes particularly in relation to physiotherapy with ESD input in patients who have had a mild to moderate stroke.

Patient satisfaction and outcomes of MSK pain patients accessing Advanced Physiotherapy Practitioner in primary care

The service objectives are to:

  1. Reduce workload of GPs
  2. Provide assessment and self-management
  3. Provide high quality care and a good patient experience to patients with MSK problems
  4. Support patients to remain in/return to work
  5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.

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