Development of the Advanced Physiotherapy Practitioner In Managing Acute Orthopaedic Injuries Previously Managed by Orthopaedic Consultants

Purpose

The development of this post in Orthopaedics was to assess whether patients with acute Orthopaedic trauma, traditionally managed by an Orthopaedic Consultant, can be independently managed by an Advanced Physiotherapy Practitioner who can also provide timely, effective and appropriate physiotherapy based interventions. The aim of this development of this post was to:

· Allow patients with certain conditions to be assessed, investigated and treated by a clinician who would provide appropriate advice.

· Allow patients to receive immediate and appropriate early rehabilitation exercises.

· Decrease the number of patients seen in Consultant return clinics and improve efficiency and patient flow in out patient clinics.

· Provide flexibility within the Orthopaedic service for Consultants to manage their out patient caseload.

· Challenge the current medical led model on acute fracture management.

36%
decrease in the number of patients seen in 10 Consultant Led Trauma clinics.

Approach

Clinical Audit to facilitate Service Evaluation.

Outcomes

Results: Analysis demonstrates that, with close collaboration with the Orthopaedic Service, an Advanced Physiotherapy Practitioner can successfully integrate and independently manage an acute orthopaedic caseload. The Orthopaedic Service benefits from a 43-52% decrease in acute trauma patients in individual Consultant Led return clinics. There is a total of 36% decreased in the number of patients seen in all 10 Consultant Led Trauma clinics. Patient satisfaction following assessment and treatment from the APP is high.

Conclusion(s): NHS Scotland wants to develop transformational posts that benefit services, patients and clinicians. This clinical audit has demonstrated advances in practice and service delivery through the creation of this Advanced Physiotherapy Practitioner post. An Advanced Physiotherapy Practitioner can integrate into an Orthopaedic Service delivering autonomous and independent fracture clinics. Within clinics the APP makes clinical decisions following clinical examination about the patients current and future management of their injury. This can include imaging, removal/application of casts/splints, removal of K-wires, changes to weight-bearing status, early rehabilitation based on imaging and escalation for surgical intervention. Consultants led clinics run with less patients, therefore they are not continually overbooked, are more efficient and Consultants have increased time for more complex cases, new patients and surgery. Future work in this area is to look at the patient journey and assess whether the early intervention at the clinics by an APP reduces the amount of time needed within MSK physiotherapy for rehabilitation.

Cost and savings

Scottish Goverment initially provided funds for 1WTE B7 Physiotherapy Post.

Implications

The current model as described demonstrates the positive impact that an APP can have on the management of acute trauma Orthoapedic patient flow and experience within the Orthopaedic Service. In addition to this 1WTE APP can also reduce the out patient caseload for 10 Orthopaedic Consultants allowing them to manage their patient flow and time to be had with the more complex patients who need to see an Orthopaedic Consultant. These results are to be used to develop additional training posts within this field. This will allow increased capacity within the service and provide succession planning for the future thus creating a sustainable service.

Top three learning points

No further information. 

Funding acknowledgements

No funding.