An interview by Catherine Turnbull with the trauma and orthopaedic physiotherapist leading an acute integrated team in Norfolk
Rene Gray was just 11-years-old when his eldest brother was involved in an accident, which required spinal surgery, and it was then that his interest in physiotherapy began.
‘My brother would often talk about the physiotherapists involved in his rehabilitation, and the way he spoke about their role and how involved they were with his recovery stuck with me, so it was always in the back of my mind as a possible career choice,’ Rene says.
However, Rene initially studied psychology at Cardiff University in 2002. During this time he became fascinated with neuroscience, cognitive psychology, health psychology and examining systems of working and improving pathways.
‘I developed an interest in the brain during my psychology degree, and this then led me to look at stroke and stroke rehabilitation, and I spent more time shadowing physiotherapists.’
Following his undergraduate degree he applied to the University of East Anglia for the MSc physiotherapy degree, graduating in 2009.
‘When I qualified I worked at a private neurological rehabilitation residential unit and later at a private MSK clinic, which was a great experience of physiotherapy outside of the NHS,’ he says. ‘I started my junior rotational post at James Paget University Hospital (JPUH) in Great Yarmouth in Norfolk.
‘I progressed to a senior rotational post, and I became increasingly interested in MSK and orthopaedics.’ Five years ago he moved into his current post - orthopaedic therapy team leader - his dream role, in which he works with a fantastic team of motivated, talented therapists.
‘This is where I have been able to really make a difference to my service and patients and begin to expand my role,’ he believes.
The JPUH orthopaedic therapy team consists of five physiotherapists, three occupational therapists and four therapy assistant practitioners. They see a range of trauma patients in addition to a wide range of elective procedures.
Rene is proud of the team’s achievements over the last couple of years not just in terms of metrics and outcome measures, but also in how they responded to Covid-19 and how any idea he wants to try is wholeheartedly embraced. He also appreciates how the close-knit and supportive team stepped up to support him when his mother died.
He has introduced several pioneering initiatives to promote effective rehabilitation and has seen first-hand the benefits of the CSP’s standards for high quality rehab after hip fracture to help transform lives and maximise independence (HipSprint).
‘I was fortunate to be involved early in my role, in the national HipSprint audit in 2017 and continue to re-audit and improve our service using the PDSA (Plan-Do-Study-Act) cycle,’ he says.
‘Our results showed the improvements we had hoped for when we completed HipSprint 2, and it was these results I presented at a CSP East Midlands event.
‘Using the CSP’s seven standards, following the findings from the first national audit, I developed a sticker to put in patient notes for each physiotherapy session, which captured the relevant information related to standards 1-5 and 7.
‘I designed these to improve consistency of approach for new starters, locums, students in the team and to make it easier to audit any aspect of the standards. This would not have happened without HipSprint.’
He says the response to the presentation gave him the confidence to go back to work with a new energy to shout about what the team was doing.
‘The resources and support given at the CSP local events really helped to improve my ability to engage the right stakeholders, and focus my future audit and quality improvement projects,’ he adds.
‘I feel the benefits of the CSP HipSprint journey has allowed an evolution of our service and my own ability to effectively demonstrate the benefits of acute femoral fracture rehabilitation.’
Involving healthcare assistants
Rene is also proud of a physio-led Out of Bed Project. An audit completed by the orthopaedic integrated therapy team last year highlighted that a disproportionate number of patients remain in bed if not seen by a physiotherapist and that they were more likely to have issues related to post-operative confusion, pain or low blood pressure.
It made no sense for patients to stay in bed until they had seen a physio, and then have most of the physiotherapist’s first contact being spent on only being able to get them out of bed,’ Rene says.
‘The project is really positive as it was achieved through a physiotherapy-led education programme for our healthcare assistants, which empowered them to mobilise more patients from their beds earlier and prior to physiotherapy assessment in suitable cases.
‘This has reduced the reliance on the physiotherapist to get someone up and allows us to focus our time and skills on progressing beyond mobilising out of bed on the first day. It includes more focus on strength and balance training, goal setting and orientating patients to reduce the risk of post-operative delirium. This is something I am hoping to expand further as a programme in the hospital.’
An additional benefit of HipSprint is that Rene has received a National Institute for Health Research (NIHR) fellowship award for a pre-masters bridging programme, which will build on his HipSprint audit work.
He was encouraged to apply by senior nurse colleague Claire Whitehouse, who has also received an award.
‘I will be looking at how we can improve the quality of clinical care provided to patients following femoral fracture and subsequent surgery.’
His hopes are that he will further develop his role in innovative ways, to better support patients using best practice and research.
‘I have been involved with the current Profher-2 trials looking at the best management for humeral fractures and am really excited to see the outcomes from this.’
He believes that evidence and research are important to be able to develop as AHPs and improve services and he hopes others within the therapies department will consider applying for research fellowships in the future.
Covid-19, he says, has allowed the team to improve and speed up some processes and challenge old ways of working.
‘One benefit was that with the decreased elective activity we were able to focus more time and attention on our trauma patients and this included starting the out of bed project.’
The virus prompted the department to create a video of their joint education class, which elective joint replacement patients attended in the hospital. Now patients have a link to the video to re-watch at home as much as they like prior to surgery.
His next aim is to further improve the pathways between the acute and community orthopaedic therapy teams for trauma patients.
Rene is never one to miss an opportunity. ‘One thing I would say to people is to be brave and take opportunities when they present themselves. The CSP are really supportive and it can lead to any number of possibilities.’
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