18 Week RTT – MSK Event Judith Park, General Manager for Surgical and Critical Care.
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Transcript of 18 Week RTT – MSK Event Judith Park, General Manager for Surgical and Critical Care.
![Page 1: 18 Week RTT – MSK Event Judith Park, General Manager for Surgical and Critical Care.](https://reader031.fdocuments.net/reader031/viewer/2022032606/56649eb55503460f94bbd338/html5/thumbnails/1.jpg)
18 Week RTT – MSK Event
Judith Park, General Manager for Surgical and Critical Care
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Programme for the DayTime Item Lead & Session Outline
10.00 – 10.15 Welcome & Overview of the Programme for the Day
Judith Park, General Manager for Surgery and Critical Care
10.15 – 10.45 Introduction of Patient Advice Line
Ruth Currie, Senior Physiotherapy
10.45 – 11.45 Development of MSK Model J Thompson, Consultant Physiotherapist MSK Services
11.45 – 12.00 Questions
12.00 – 12.45 Lunch & Networking
12.45 - 13.45 Moving ForwardE clinic, national pilot
J Thompson, Consultant Physiotherapist MSK Services
13.45 – 14.00 Close Judith Park, General Manager for Surgery and Critical Care
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SELF REFERRAL TO PHYSIOTHERAPY
RUTH CURRIEPHYSIOTHERAPY TEAM LEAD
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BACKGROUND
• 2007/8 – Physiotherapy waiting lists across NHS Lanarkshire inequitable. Varying from 3-4 weeks in some sites to 36 weeks in others
• NHS L had never introduced self referral to Physiotherapy in any format
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AIMS
• To create equity in waiting times across NHS L
• To reduce waiting times for physiotherapy across NHS L
• To increase access to Physiotherapy• To offer advice and enable some to
self manage their condition
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THE PILOT PHASE
• An 18 month preparatory phase in 2008/9 to reduce waiting times and waiting lists
• Temporary staff employed for 18 months• A 6 month trial of the a telephone self
referral service to Physiotherapy in 2 locations – Clydesdale (rural) and Motherwell (urban)
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THE ROLL OUT
JANUARY 2010
PHYSIOTHERAPY ASSESSENT LINE
(PAL)
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Monday to Friday
9am – 12 noon
Open to all adults who live in Lanarkshire who have a musculo-skeletal problem for which Physiotherapy advice or intervention may be of benefit
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Patients must be :• Able to communicate via the telephone
• Present to give their consent
• Be available for assessment within office hours
• If not, a GP referral may be more appropriate
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THE SYSTEM
• Telephone system
• Computer database
• Experienced clinicians
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TELEPHONE SYSTEM
• A single telephone number for every Lanarkshire resident to use
• 01236 713901
• Through an English based Telephonetics system
• No queuing
• A voice mail option
• Up to 30 incoming telephone lines
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COMPUTER BASED SYSTEM• An electronic physiotherapy assessment
• Linked in with CHI so demographics can be pulled down for Lanarkshire residents
• A clinical based assessment tool
• The telephone assessment takes on average 10 – 15 minutes
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EXPERIENCED CLINICIANS
• All band 6 and 7 MSK physiotherapists
• Some band 5 Physiotherapists who had at least 2 years MSK experience with sound clinical reasoning skills and well developed communication skills
• Over 60 physiotherapists currently involved
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TRAINING PROGRAMME– 1.5 hour teaching session with PAL
manual and introduction to the IT system
– A 1.5 hour mock call session
– A 1.5 hour supervised call back session
Then Go Live!
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VOICE MAIL
• Computer based secure call back site for all voicemails
• SLA is to call back those who leave a message within 2 working days
• X2 attempts made to reach the patient
• Voice message left
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A TYPICAL DAY
• 9am – 12 noon : up to x10 physiotherapists ‘live’
• Each physiotherapist can take between 10 and 15 calls
• 1.30pm – 4.30pm : up to 3 physiotherapists on ‘call backs’
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CALL OUTCOME• Self Manage and Discharge• Routine Appointment• Urgent Appointment• Emergency Referral to A&E• Information only• Advised GP visit• Salus – Health for Employability• Salus – Working Health Services
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Self Manage and Discharge
Option to- Send some simple evidence based
exercises for specific joints/ conditions- Direct to evidence based web pages- Information can be sent via email (non
reply email address for PAL)- Ask to call back within a specific time
period if no or limited improvement
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Appointed patients
• Referral sent electronically to our 26 MSK sites and downloaded daily
• Each department follows the same MSK prioritisation criteria
• Routine – within 9 weeks• Urgent – within 5 working days
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Emergency Referral
• Any patient who, through the clincial reasoning process, is identified to be suffering from a condition which may require immediate medical attention
(eg: cauda equina)
Physiotherapist phones ahead to A&E and speaks to the receiving registrar.
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Information Only
• Enquiries regarding uplift or return of equipment, appointment times, referral processes, etc
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Advised GP visit
• To discuss medication / pain control• For a written referral if
communication not possible via the telephone
• For outcome of investigations
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Salus – Health For Employability
• For those who are unemployed and who have a health condition which may be preventing them from accessing employment or training
• A case management approach
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Salus – Working Health Services
• Private Physiotherapy provided for those who are self employed or who work for a small business of less than 250 employees.
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2010 Data
Incoming calls – 31,488Calls answered – 12,230Completed Assessments –
11,688Referrals to Physiotherapy - 8621
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2011 Data to end September
Incoming calls – 31,947Calls answered – 13,751Completed assessments –
12,814Referrals to Physiotherapy - 9151
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INCOMING CALLS
0
200
400
600
800
1000
1200
1400
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89
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INCOMING CALLS V CALLS ANSWERED
0
200
400
600
800
1000
1200
1400
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
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DATA FOR PERIOD JANUARY 2010 TO JULY 2011
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REFERRAL TYPE
TRUE9%
SUGGESTED91%
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GENDER
MALE40%
FEMALE60%
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AGE RANGES
975
572
753
1145
1597
706
393
0
200
400
600
800
1000
1200
1400
1600
1800
<16 16-20 21-30 31-40 41-50 51-64 65-74 >75
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EMPLOYED V NOT EMPLOYED Jan 10 - July 11
12307, 48%
5063, 19%
8643, 33%
EMPLOYED NOT IN EMPLOYMENT UNDER 65 NOT IN EMPLOYMENT OVER 65
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CALL OUTCOMES
APPOINTMENT ROUTINE60%APPOINTMENT URGENT
16%
SELF MANAGE AND DISCHARGED22%
ADVISED GP VISIT2% EMERGENCY REFERRAL
0%
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PATIENT CONDITION
1378
683
1303
621
795
196
116
8 00
200
400
600
800
1000
1200
1400
1600
ALBP NECK UPPER LIMB KNEE LOWER LIMB MULTI OTHER NEURO UROLOGY
NU
MB
ER
OF
RE
FER
RA
LS
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REFERRALS TO CLINICS
175
109 110
311
506
71
227
36
133
4927
179
106
23
106
203
33
104
152
307
214
133
257
131
552
0
100
200
300
400
500
600
NU
MBE
R O
F R
EFER
RA
LS
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The Benefits of Self Referral to Physiotherapy
PAL
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Benefits to the Patient
• Immediate access to Physiotherapy advice
• Experienced clinician with sound clinical reasoning skills
• Access to electronic or paper based advice and exercise
• An alternative method of referral
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Benefits to the GP
- PAL business cards available in all GP practices
- Less time consuming than writing or dictating a written referral
- Cost effective- Places the onus on the patient to
initiate the referral
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Benefits to Physiotherapy Service• More accurate information on the
referral• Patient usually already commenced
some home exercise or advice• A percentage self manage • Reduced inappropriate referrals• Reduced NP : Return patient ratio• Equitable waiting lists and times
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The Challenges
• Answering all our incoming calls• Coping with computer crashes• Staff absence / holidays• Balancing time on telephone
assessment with 1:1 patient assessment and treatment
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The Future
• NHS 24
• Janie Thomson