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Wiig S, Calderwood CJ, O’Hara J. Sailing Too Close to the Wind? How Harnessing Patient Voice Can Identify Drift towards Boundaries of Acceptable Performance. Healthcare (Basel) 2024; 12:1532. [PMID: 39120235 PMCID: PMC11312204 DOI: 10.3390/healthcare12151532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
This opinion paper investigates how healthcare organizations identify and act upon different types of risk signals. These signals may generally be acknowledged, but we also often see with hindsight that they might not be because they have become a part of normal practice. Here, we detail how risk signals from patients and families should be acknowledged as system-level safety critical information and as a way of understanding and changing safety culture in healthcare. We discuss how healthcare organizations could work more proactively with patient experience data in identifying risks and improving system safety.
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Affiliation(s)
- Siri Wiig
- SHARE—Centre for Resilience in Healthcare, Faculty of Health Sciences, N-4036 Stavanger, Norway
| | | | - Jane O’Hara
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge CB1 8RN, UK; jane.o'
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2
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Hepburn J. Diagnostic uncertainty and axial spondyloarthropathy: A case for cognitive debiasing through practice-based learning and improvement activity. Musculoskeletal Care 2023; 21:1463-1469. [PMID: 37776078 DOI: 10.1002/msc.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Jordan Hepburn
- Musculoskeletal (MSK) GP Advanced Practice Physiotherapy Service, Edinburgh Health & Social Care Partnership, NHS Lothian, Edinburgh, UK
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3
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Ingram S, Stenner R, May S. The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care. Musculoskeletal Care 2023; 21:644-654. [PMID: 36683250 DOI: 10.1002/msc.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/24/2023]
Abstract
AIM The aim of this research was to explore the experiences of uncertainty amongst Musculoskeletal First Contact Practitioners working in primary care. BACKGROUND The Musculoskeletal First Contact Practitioner role involves advanced physiotherapists providing an alternative to the GP by acting as first point of contact for people presenting to primary care with musculoskeletal conditions. Limited research into the role exists but the first-contact aspect, clinical complexity and time pressures are deemed to contribute to uncertainty within the role. METHOD A qualitative research design was undertaken using a hermeneutic interpretative phenomenological approach. Data was collected using semi-structured interviews with subsequent thematic analysis of the data. FINDINGS Eight participants working as Musculoskeletal First Contact Practitioners across England were recruited using purposive sampling. Five themes were identified: (1) Role clarity within primary care, (2) Burden of responsibility, (3) Preparedness for the primary care environment, (4) 'I'm not really sure how long I am going to stay in this role', (5) Mitigating uncertainty. CONCLUSION This study demonstrates the multifaceted phenomenon of uncertainty amongst Musculoskeletal First Contact Practitioners. Uncertainty appeared to be influenced by the primary care environment, preparedness for the role and perceived burden of responsibility. Diagnostic uncertainty was prevalent with concerns of missing serious pathology evident. The impact of uncertainty on wellbeing was linked to possible burnout and retention issues. Consultation approaches, access to support networks and a cultural shift in tolerating uncertainty were reported to mitigate uncertainty. Further research into possible differences in experiences related to employment models appears warranted.
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Affiliation(s)
- Simon Ingram
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK
| | - Rob Stenner
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK
| | - Sue May
- School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, Devon, UK
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4
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Paling C, Hutting N, Devoto K, Galdeano J, Josling K, Goodway L. A service evaluation of the management of patients with suspected cauda equina syndrome from an outpatient physiotherapy service in the United Kingdom. Musculoskelet Sci Pract 2022; 62:102673. [PMID: 36335852 DOI: 10.1016/j.msksp.2022.102673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The expanding scope of physiotherapists worldwide has come with an increased responsibility to identify serious pathologies such as fracture, infection, tumour and cauda equina syndrome (CES). Guidelines recommend a low threshold for emergency MRI to avoid the potentially devastating consequences of CES, but a balanced approach is required to prevent excessive strain on emergency resources. AIM To evaluate the management of patients presenting to an outpatient physiotherapy service with suspected cauda equina syndrome. DESIGN Service evaluation with an embedded case series of patients with radiological CES. METHOD The records of patients who were identified by their outpatient physiotherapists as having suspected CES (n-231) over a 27-month period were included. Data was extracted from patients' medical records by a team of Advanced Clinical Practitioners (ACPs). The lead author further analysed the records of patients with clinical and radiological CES, in order to present the embedded case series. RESULTS In 79% of cases, it was decided that emergency referral was not required. The remaining 21% of patients were referred to the emergency department and 49% of these had an emergency MRI. In the case series of seven patients with cauda equina compression on MRI, four patients had a disc bulge and underwent emergency surgery. One patient had non-emergency surgery for a disc bulge combined with anterolisthesis and scoliosis. Two patients had stenosis and decided against surgical intervention. CONCLUSIONS Findings from this service evaluation suggest support for the use of safety netting and an effective communication chain to facilitate effective management of patients with suspected CES.
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Affiliation(s)
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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5
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Slattery B, Ackerman L, Jagadamma KC. Service evaluation of telehealth in a physiotherapy musculoskeletal setting: Patient outcomes and results from risk stratification. Musculoskeletal Care 2022; 20:977-990. [PMID: 35220671 DOI: 10.1002/msc.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Due to COVID-19 the ability to see all patients face-to-face (FTF) was removed. Services implemented telehealth to cater for patients requiring musculoskeletal care. A service evaluation was undertaken to assess the effectiveness of a mixed telehealth/FTF approach and identify if stratifying patients could help tailor intervention. METHODS Retrospective analysis of data collected from patients who were assessed by Musculoskeletal Physiotherapists in one Scottish health board was undertaken. Patients were divided into low, medium and high risk sub-groups through the Keele STarT MSK tool. Outcome measures for pain and musculoskeletal health were taken at baseline/discharge along with satisfaction/preference. Descriptive and Inferential statistical analysis was conducted to establish whether changes in the outcome measures within and between risk sub-groups were statistically significant. RESULTS Pain level difference from baseline to discharge demonstrated clinically and statistically significant improvements across all risk groups (N = 89). Musculoskeletal health demonstrated clinically significant improvements across all risk groups and statistically significant improvements in the medium/high risk groups but not the low risk. Patients with knee osteoarthritis and low back pain in the medium risk group had fewest appointments while patients with chronic shoulder pain had the most. The majority of patients were satisfied with all mediums but preferred FTF or an option between telehealth/FTF in the future. CONCLUSION Telehealth is a promising model of care when utilised in combination with FTF for patients with musculoskeletal conditions. Through stratification, identifying specific conditions and shared decision making it may be possible to treat certain patient groups via telehealth.
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Affiliation(s)
- Brian Slattery
- Department of Physiotherapy, NHS Lanarkshire, Coatbridge, UK
| | - Lyndsey Ackerman
- Department of Physiotherapy, Queen Margaret University, Musselburgh, UK
| | - Kavi C Jagadamma
- Department of Physiotherapy, Queen Margaret University, Musselburgh, UK
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6
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Duffy S. Understanding patient assessment and treatment in deep vein thrombosis. Nurs Stand 2022; 37:71-75. [PMID: 36278279 DOI: 10.7748/ns.2022.e12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Deep vein thrombosis (DVT) commonly develops in the deep veins of the legs, but it can potentially form in any part of the body. There are several risk factors associated with DVT including prolonged immobility, malignancy, recent surgery and family history. One of the main risks of DVT is that the thrombus that has formed in a vein may travel through the body and become lodged in the pulmonary system, causing a pulmonary embolism, which is life-threatening. In the UK, specialist services and diagnostic pathways have been developed to speed up the diagnosis and treatment of DVT, many of which are now nurse-led. This article uses a case study to outline the assessment of patients with suspected DVT and the treatment of patients with a confirmed diagnosis of DVT.
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Affiliation(s)
- Sinead Duffy
- King's College Hospital NHS Foundation Trust, London, England
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Finucane LM, Greenhalgh SM, Mercer C, Selfe J. Defensive medicine: A symptom of uncertainty? Musculoskelet Sci Pract 2022; 60:102558. [PMID: 35367770 DOI: 10.1016/j.msksp.2022.102558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
Defensive medicine is a well-documented phenomenon and refers to the practice of over-cautious management of patients, leading to excessive clinical activity such as over-investigation, unnecessary appointments and additional interventions. Adopting this approach is not in the best interest of patients and can lead to clinical reasoning being replaced by lists, guidelines and algorithms which do not consider the complexity of a patients presentation or the reasoning inherent in good clinical judgement. The drivers of defensive medicine are varied and include a high level of uncertainty alongside other factors including clinical experience with past cases, system pressures and patient expectations. This paper explores these drivers and considers strategies on how best to avoid a defensive medicine approach. It reinforces the need to adopt a patient centred focus and use sound clinical reasoning to support the management of patients.
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Affiliation(s)
- Laura M Finucane
- Sussex MSK Partnership, Brighton, UK; Department of Health, Social Care and Education, St Georges University London, UK.
| | - Susan M Greenhalgh
- Bolton NHS Foundation Trust, UK; Department of Health Professions, Manchester Metropolitan University, UK
| | - Christopher Mercer
- Western Sussex Hospitals NHS Trust, Chichester, UK; University Hospitals Sussex NHS Trust, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, UK; Physiotherapy Department, Satakunta University of Applied Sciences, Pori, Finland
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8
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Friedemann Smith C, Lunn H, Wong G, Nicholson BD. Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care. BMJ Qual Saf 2022; 31:541-554. [PMID: 35354664 PMCID: PMC9234415 DOI: 10.1136/bmjqs-2021-014529] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk. OBJECTIVE To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care. METHODS Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives. RESULTS 95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care. CONCLUSIONS We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.
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Affiliation(s)
| | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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9
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Socioeconomic differences in help-seeking experiences in primary care for symptoms related to colorectal cancer during COVID-19: A UK-wide qualitative interview study. Br J Gen Pract 2022; 72:e472-e482. [PMID: 35636968 PMCID: PMC9256043 DOI: 10.3399/bjgp.2021.0644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes. Aim To understand how patients’ help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES). Design and setting Qualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES. Method Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups. Results Three themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients. Conclusion The findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.
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10
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Gilbert AW, Jones J, Stokes M, May CR. Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID-19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting. Health Expect 2022; 25:775-790. [PMID: 35014124 PMCID: PMC8957728 DOI: 10.1111/hex.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
AIM To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID-19. To understand how patient preferences are constructed and organized. METHODS Semi-structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged. RESULTS Fifty-five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process. CONCLUSIONS This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID-19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations. PATIENT AND PUBLIC CONTRIBUTION The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.,Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, North Thames, UK
| | - Jeremy Jones
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, Wessex, UK
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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11
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Moore AP, Jull G. Patient's perspectives of musculoskeletal science and practice. Musculoskelet Sci Pract 2021; 55:102436. [PMID: 34358760 DOI: 10.1016/j.msksp.2021.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Paling C. The complex problem of identifying serious pathology in Musculoskeletal care: Managing clinical risk during the COVID pandemic and beyond. Musculoskelet Sci Pract 2021; 54:102379. [PMID: 34052175 DOI: 10.1016/j.msksp.2021.102379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022]
Abstract
The expanding scope of physiotherapists has come with an increased level of responsibility to identify 'red flag' signs and symptoms. Red flags can indicate the presence of serious pathology but are notoriously unreliable. This leaves diagnosis heavily reliant on diagnostic investigations which are generally a finite resource within healthcare organisations. The COVID pandemic seems to have further compounded the problem and the possibility of 'missed' or 'delayed' diagnosis is ever-present. This may present a threat to patients' lives, to clinicians' careers and wellbeing, and to organisations' finances and reputations. Although clinical risk in musculoskeletal physiotherapy may never be eliminated, there are opportunities to work towards minimising it. This professional issue will explore the complex problem of identifying serious pathology in musculoskeletal care and will propose strategies to manage the associated risks during the COVID pandemic and beyond. A video abstract is included in Appendix A.
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Affiliation(s)
- Claire Paling
- Wiltshire Health and Care, Outpatient Physiotherapy, Level 3, Salisbury District Hospital, Odstock Road, Wiltshire, SP1 3QU, UK.
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13
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Barbaro K, Midgley J. Priapism, a symptom of claudication of the cauda equina in spinal stenosis. Musculoskelet Sci Pract 2021; 52:102337. [PMID: 33549525 DOI: 10.1016/j.msksp.2021.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
Priapism is defined as a persistent penile erection in the absence of sexual arousal. This symptom has been documented in patients with spinal stenosis although it is considered a rare finding. The European Association of Urology guidelines on priapism [Salonia et al., 2014] list cauda equina syndrome and spinal stenosis as causative factors for ischemic priapism although the literature describing this phenomenon appears sparse. Priapism can be a rare symptom of lumbar spine stenosis/transient cauda equina compression. This presentation is complex and believed to be a parasympathetic mediated autonomic disorder. This article discusses the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. Greater awareness of this clinical finding may help clinicians in their clinical decision making. In patients with suspected cauda equina syndrome, subjective enquiry regarding the symptom priapism may add to the patients overall clinical picture.
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Affiliation(s)
- Karl Barbaro
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
| | - James Midgley
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
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14
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Kelly M, Higgins A, Murphy A, McCreesh K. A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study. Arch Physiother 2021; 11:4. [PMID: 33550990 PMCID: PMC7868119 DOI: 10.1186/s40945-020-00098-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/26/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. METHODS This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. RESULTS Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3-8 days) compared to those that opted for usual care (median 35 days; 19-39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. CONCLUSION A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.
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Affiliation(s)
- Marie Kelly
- Department of Physiotherapy, Mercy University Hospital, Grenville Place, Cork, T12 WE28 Ireland
| | - Anna Higgins
- Department of Physiotherapy, Mercy University Hospital, Grenville Place, Cork, T12 WE28 Ireland
| | - Adrian Murphy
- Emergency Department, Mercy University Hospital, Cork, Ireland
| | - Karen McCreesh
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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15
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Drake C, Hicks N, Atkin L. Developing patient information and clinician education resources for venous thromboembolism in a physiotherapy department in response to the COVID-19 pandemic. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2020.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous thromboembolism is a major contributor to global disease burden and is associated with significant morbidity and mortality. Physiotherapists often encounter people who are at elevated risk of venous thromboembolism, and as such are a vital part of an interdisciplinary approach to the prevention and management venous thromboembolism. In response to the COVID-19 pandemic, appropriate and accessible patient and clinician information resources regarding venous thromboembolism are of paramount importance, to facilitate safety netting and optimise health outcomes with minimal face-to-face contact. This article describes an interdisciplinary approach to the development of patient and clinician information resources within an acute hospital physiotherapy department in the UK. This was conducted with the intention of providing appropriate safety netting for patients at risk of lower extremity venous thromboembolism and to actively facilitate prevention, detection and early intervention.
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Affiliation(s)
- Chris Drake
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Nicola Hicks
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Leanne Atkin
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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