deborah lenaghan advanced scope physiotherapist dr paul bowe director ed robina extended scope of...
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Deborah LenaghanAdvanced Scope Physiotherapist
Dr Paul BoweDirector ED Robina
Extended Scope of PhysiotherapyEmergency Department
Health Workforce Australia (HWA) Funded Project 2012-13
SERVICE DETAILS
Robina Hospital is an acute bed (360) hospital and is part of the Gold Coast Hospital and Health Service
GCHHS had 125,745 ED presentations 12/13financial year, Southport 69,076 ( NEAT 64%) Robina 56,667 (NEAT 79%)
NEAT Targets to be phased in 2015Jurisdiction Baseline 2012 2013 2014 2015
NSW 61.8% 69% 76% 83% 90%
VIC 65.9% 72% 78% 84% 90%
QLD 63.8% 70% 77% 83% 90%
WA 71.3% 76% 81% 85% 90%
SA 59.4% 67% 75% 82% 90%
TAS 66.0% 72% 78% 84% 90%
ACT 55.8% 64% 73% 81% 90%
NT 66.2% 72% 78% 84% 90%
ENABLERS The Districts focus on NEAT performance Austerity measures. State wide Ministerial Taskforce on
Expanded Scope of Practice underway. Networks
Performance against NEAT- Robina
Jan-
12
Feb-1
2
Mar
-12
Apr-1
2
May
-12
Jun-
12
Jul-1
2
Aug-1
2
Sep-1
2
Oct-1
2
Nov-1
2
Dec-1
2
Jan-
13
Feb-1
3
Mar
-13
Apr-1
3
May
-13
Jun-
13
Jul-1
3
Aug-1
3
Sep-1
3
Oct-1
3
Nov-1
30
10
20
30
40
50
60
70
80
90
100
ESP commenced
District focus on Neat
PCP ROLE TURN AROUND TIME 90 mins EARLY ASSESSMENT and
INVESTIGATION AFTER TRIAGE TREATMENT PT EDUCATION and EXPECTATIONS
regarding RECOVERY
S93.40 148 Ankle- Sprain / Strain
S52.50 100 Fractured Radius
T00.2 60 Contusions Lower Limb
S62.0 58 Fractured Scaphoid
T00.3 56 Contusions Upper Limb
S92.2 54 Fractured Lower Limb
S63.50 50 Wrist -Sprain /Strain
S82.4 48 Fractured Fibula
S62.6 39 Fractured Finger
M24.2 38 Knee ligament or tendon injury
Others 711
TOTAL 1362
Top 10 Oct12- Sep 2013
Percentages of through put
Patient ComplimentsCompletely professional, extremely efficient.
I was absolutely taken a back, by how quickly things were moving. Having been to the Emergency Dept on a number of occasions and having to sit through very long waits,
I found this new system to be a breath of fresh air.
I felt it important to pass on my positive feedback,
I would also like to emphasise the care that we received was faultless. polite, friendly, efficient and very professional.
I would like to congratulate the Hospital for looking at ways to improve their services.
This program can only be a good thing and I hope it will continue indefinitely.
COMPLIMENTS
STAFF SURVEY PRELIMINARY RESULTS ONLY Provided by Cristina J Thompson @ University of Wollongong
Terminology: Primary Contact Physiotherapist PCP
STAFF SURVEY 52 RESPONDENTS
52 RESPONDENTS
LEVEL OF AGREEMENT
Strongly agree1
2 3 4 Strongly disagree5
The PCP improves quality of care of musculoske-letal presentations
73% 17% 8% 0% 0%
Strongly agree1
2 3 4 Strongly disagree5
The PCP improves access to emergency care
73% 17% 8% 0% 0%
Strongly agree1
2 3 4 Strongly disagree5
The ED PCP makes the ED team more effective
75% 15% 8% 0% 0%
Strongly agree1
2 3 4 Strongly disagree5
I have a good understand-ing of how the PCP will function in my ED
54% 37% 4% 4% 0%
Strongly agree1
2 3 4 Strongly disagree5
The PCP has the skills and knowledge to prescribe medications from a limited formulary
33% 37% 12% 4% 2%
Strongly agree1
2 3 4 Strongly disagree5
I have a good understand-ing of the educational preparation to become a PCP
29% 31% 23% 2% 6%
THEMES from STAFF
• improved patient flow within the Fast Track zone of the ED and contributed to improvements in NEAT performance
• improved patient care for patients presenting with a musculo-skeletal injury
• contributed to the education and mentoring of other ED personnel through their advanced knowledge and expertise in managing musculo-skeletal presentations
• complemented the skill mix of the ED
STAFF COMMENTS
• “The primary contact physiotherapist role in ED is beneficial for patients and staff alike. There is a definite improvement in flow through fast track. The physio has an excellent knowledge base and is certainly an asset to the department.”– Nursing staff
• “It is hugely helpful having an ED primary contact physiotherapist in the department. They are extremely valuable members of the team and their knowledge and expertise are vital in the ED setting. They provide excellent care to the relevant patients and make a positive difference to the work load.” – Medical staff
STAFF COMMENTS
• “The ED primary contact physiotherapist complements well the skill mix of the ED team to care for patients with musculoskeletal problems and has worked extremely well in our ED.”
• – Medical Staff
STAFF COMMENTS
• “… The physiotherapists increased knowledge of fractures and mechanisms of injury has improved the patients’ process through the ED department, with more relevant requests and many diagnoses have been made that might have been missed without her input.”– Allied Health Staff
SOME CONCERNS
• the usefulness of the role may be dependent on the person in the role
• there appears to be reluctance by some inpatient medical officers to accept referrals from the PCP
• the outcomes of the PCP should be understood in relation the specific patient cohort managed and that this may not be representative of outcomes for other patients managed in the Fast Track zone of the ED
• the patient cohort seen by the PCP should be appropriate to the role, for example, Triage Category 2 patients may not be appropriate.
Re-presentation rates
1 2 3 4 5 6 7 8 9 100
2
4
6
8
10
12
Representation rate % 7 days (1-15)
Linear (Representation rate % 7 days (1-15))
Representation rate % 28 days (1-15)
Linear (Representation rate % 28 days (1-15))
Robina DNW %
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sept
0
2
4
6
8
10
12
Robina DNW's %
%
Embedding the Role Recognised and reported on at an Executive
Level. Supported verbally at a local level by the
Directors of ED. Continued positive feedback from ED staff and
Patients. Local and National Evaluation being undertaken.
FUTURE SUSTAINABILITY Uncertainty - HH& S restructuring to
service line management model Funding
Influential Relationship Development Time
Respect
Flexibility
CONCLUDING THOUGHTS PCP selection Challenging traditional medical roles ED design (waiting rooms & treatment
areas) Emphasis of patient flow and journey Training ED team in MSK conditions
Deborah LenaghanAdvanced Scope Physiotherapist
Dr Paul BoweDirector ED Robina
Extended Scope of PhysiotherapyEmergency Department
Health Workforce Australia (HWA) Funded Project 2012-13
Percentage seen in clinically recommended time