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 PDSA project was registered with the locality manager. Actions included:
1. Prospectively providing an email summary of CRT intervention to the CLFC.
2. Provision of a CRT physiotherapy band 4 assistant practitioner (physiotherapy associate) to attend the weekly CLFC to:
a. Facilitate reciprocal learning opportunities.
b. Offer basic walking aid assessments, sign posting, falls prevention advice and encouragement to increase activity, along with supporting written information from Age UK or the CSP.
c. Complete an anonymous outcome record, including clinical frailty score, short falls efficacy scale, number of sit to stands in 30 seconds.
d. Support the identification of an exit pathway from the clinic- Supported by CRT guidance, patients could choose one or more of the following:
i. One off intervention and no further follow up.
ii. CRT referral for a home assessment.
iii. A follow up phone call or visit by a therapy assistant.
iv. Addition to the agenda of the weekly, primary care hub, frailty meeting for case management.
v. Onward referral to the postural stability group, third sector services, social prescriber or community coordinator (of statutory services).
vi. Option for later self-referral for individuals previously seen by the CRT, should they express an interest in rehabilitation at a later date.
Physiotherapists attended once every 2 months for their own learning. Following trial and error, the outcome measures (action point c) were removed due to time limitations and to prevent disrupting clinic flow.
Audit showed a 54% reduction in onward CRT referrals, with integration eliminating unnecessary referrals back to the team. Individuals who consented to a physiotherapy referral were well informed and engaged. Immediate issues such as walking aid assessment were addressed, eliminating a prolonged wait on the routine waiting list. Referrals to community services were coordinated to improve the individual's, informed journey. Referral traffic through our administration process reduced.
Initial findings support integration of a physiotherapy assistant with the CLFC as a way of managing finite resources and providing timely intervention for patients.
CRTs across the Country may operate very differently and have different demands depending on their circumstances and commissioning. These results suggest that further integration of the CRT with high referral generators may benefit both the patient and CRT operational efficiency.
Top three learning points
This work in unfunded.
This work was presented at Physiotherapy UK 2019
Please see the attached Innovations poster below.
For further information about this work please contact Vicky Farrell.