Children with disabilities have multiple health appointments. Travel, unfamiliar environments and professionals can cause distress to the child and family.
Outreach clinics provide orthopaedic assessments following the Cerebral Palsy Integrated Pathway (CPIP) assessment guidance for all children (including Non-CP). This Physiotherapy-led clinic is run jointly between the Royal London Hospital (RLH) and the local community physiotherapist, aiming to reduce the burden of multiple appointments for families and improve communication between local and tertiary clinicians.
Treatment decisions where appropriate (Botulinum toxin injections) can be made in clinic and if surgery is indicated this can be discussed with the parents within this setting prior to the next appointment in the consultant led clinic to fully discuss and book surgery.
This project is a service evaluation of the newly implemented orthopaedic outreach clinics lead by the Royal London hospital in conjunction with the local Child Development Centres (CDC`s).
R.T (RLH) contacted referring CDCs to arrange initial meetings. Currently seven CDCs had meetings, and four had outreach clinics.
Patients were identified from caseload-databases, if orthopaedic consultants agreed, an X-ray and outreach appointment was arranged locally.
Families received calls and letters for the outreach and X-ray appointments. The X-rays were retrieved through PACS system, and analysed prior to clinic.
A parent satisfaction questionnaire and qualitative interviews with Physiotherapists were used to gather feedback.
Our results show good attendance for both X-ray and outreach appointments.
The survey showed that families felt this was a “Fantastic” service in 81% (35/43), “Good” Service in 13% (6/43), between Good to fantastic in 2.3% (1/43) and no response was given in 2.3% ( 1/43).
“ Much easier at Newbridge [School] as parking is difficult at RLH”
“ It is really good to see child local, as so local and hospital know what is going on with child. Happy and useful”
A total of 16 children had x-rays taken locally parents reported this to work “Fantastic” 68% (11/16), “Good” in 18.7%(3/16), “OK” in 6.2% (1/16) and “Poor” in 6.2% (1/16).
26 children who were seen in outreach did not require a x-ray to be taken for the appointment.
Staff reported improved care through involvement in decision making, ease of intervention planning, reduced appointments and improved communication.
“I Have used the outreach clinic as review session rather than double up seeing patients and families twice and duplicating documentation”.
Despite being administrative heavy, joint efforts of all professionals involved enabled successful outreach clinics. Different strategies to request local x-rays were implemented, these are further of use for the implementation of the Cerebral Palsy Integrated Pathway for hip surveillance.
Good attendance for both the appointments and x-rays further highlights the positive impact the orthopaedic outreach clinics have on transforming patient care.
The positive feedback received from both clinicians and parents shows that the goal of reducing the burden of care to families with severely disabled children was achieved. Additional clinics in other boroughs are currently being planned and the established clinics expanded.
No additional funding was received for this project.
This work was presented at Physiotherapy UK 2019 and presented at the European Academy of Childhood Disability a multidisciplinary conference in May 2019.