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Twilight service brings benefits

Physiotherapists in Scotland who piloted a ‘twilight’ service in an acute hospital have reported a fall in ‘inappropriate’ emergency call-outs, as well as other benefits.

The experiment took place at Raigmore hospital, Inverness, following an audit.

Suzanne Lindsay, superintendent physio for intensive care, said: ‘We noticed that 70 per cent of our call-outs were happening before 9pm. We wondered if we offered a twilight service up to 9pm whether that would absorb our calls and cut down on our on-call figures.’

Two eight-week pilots were set in motion after physios secured £5,000 funding. The first pilot ran during September and October last year and was staffed by physiotherapists from 1pm to 9pm. The second pilot, in January and February this year, involved a physiotherapist recruited specifically to a new post.

The twilight service was offered to departments including accident and emergency, orthopaedics, paediatrics and respiratory. Ms Lindsay said inclusion criteria were drawn up at the end of each day.

‘People would come down and put their patients on the list. The physios would work their way through the list and could be bleeped as well.’

Referrals included A&E patients who required assessment, advice, support or equipment that would prevent their admission, and orthopaedic patients who required a final check, such as a stair test, to enable early discharge.

Around 400 patients were seen overall. There was a ‘noticeable reduction’ in the number of emergency duty call-outs.

Clinicians reported significant improvement in speed and effectiveness of treatment, with early and timely intervention preventing escalation of care.

Physiotherapists felt there were benefits to patients but raised some concerns, for example about training and education, lone working and supervision.

Ms Lindsay said: ‘I think the service generally was very well received.’ She said the evidence from the pilots had implications in terms of cost savings and paying for call-outs.

There may now be a year-long trial to collect ‘more robust’ data before deciding if the service should be continued permanently.

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