Prior to this pilot, there was no specialist respiratory input available in the community for patients with non-respiratory conditions though respiratory complications, such as spinal cord injuries, degenerative neuromuscular problems. Specialist input was available for some conditions, though often required either outpatient appointments or admission to the acute hospital in order to be seen.
Patients with a Physiotherapy amenable respiratory problem were referred in from any health care professional who has reviewed the patient for physiotherapy input to prevent hospital admission for respiratory reasons. Referrals were also accepted from the acute trust to support discharges back into the community. Examples of patients seen include those with airway clearance issues, breathing pattern disorders, and neuromuscular conditions requiring non-invasive ventilation. Each of these attends were assessed by a physiotherapist and offered an individualised treatment programme specific to their needs. Outcomes varied and depended entirely on the patient, though the main focus was often time between admissions and presumed reduction in bed days were used to show the patient the impact of physiotherapy.
Results: 14 patients were referred specifically with airway clearance issues as a result of neurological conditions. A range of diagnoses were seen, including stroke, Parkinson’s Disease, Multiple Sclerosis, Von Hippel-Lindau Syndrome, and motor neurone disease. It is estimated that an average of 30-40 bed days/year were saved across these patients, including one patient who has not been admitted for 338 days (at the time of writing) compared to 49 days between admissions prior to this input.
Conclusion(s): A community respiratory physiotherapy service for patients with respiratory complications of other conditions is essential for preventing hospital admissions, and can help to reduce length of stay for those who do need care in the acute hospital
Cost and savings
This was part of a larger pilot project, so actual cost is difficult to determine.
By implementing a Physiotherapy service as part of a wider team spanning organisations including primary and secondary care, patient care could be significantly improved, reducing absolute number of admissions and number of bed days in a non-COPD population, specifically those with progressive neuromuscular weakness disorders.
Top three learning points
No further information.
The Physiotherapy input was as part of the Integrated Respiratory Team pilot, which was funded equally by Oxfordshire CCG and Boehringer Ingelheim.