Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care

Oldmeadow, Leonie B; Bedi, Harvinda S; Burch, Hugh T; Smith, Jenni S; Leahy, Edmund; Goldwasser, Miron

doi:10.5694/j.1326-5377.2008.tb01638.x

Cited by 13 publications

(16 citation statements)

References 2 publications

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“…These findings are similar, albeit greater, to previous studies involving podiatrists performing assessment and triage roles where 41-45% of patients were discharged without requiring surgical management [8,14]. Current literature suggests allied health professionals, including podiatrists, can ease demands placed on orthopaedic outpatient services [8,9,14,16]. Importantly, as ‘Category 3’ patients generally wait the longest for a surgical consultation, the assessment and triage service allows those considered likely to benefit from non-surgical interventions to be redirected, in many cases earlier, for effective treatment.…”

Section: Discussionsupporting

confidence: 83%

“…Introducing experienced allied health professionals into orthopaedic units can be relatively seamless to implement as it utilises the skills of an existing workforce [6]. The current evidence for using allied health professionals in these roles is generally promising with studies indicating high patient and referrer satisfaction [9,11–14], reductions in waiting time [8,11], high agreement in diagnosis and management decisions with orthopaedic surgeons [9,15], and a high proportion of patients being assessed, managed and discharged without requiring a surgical consultation [8,9,11]. …”

Section: Introductionmentioning

confidence: 99%

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Evaluating the outcomes of a podiatry‐led assessment service in a public hospital orthopaedic unit

Bonanno

Medica

Tan

et al. 2014

Journal of Foot and Ankle Research

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BackgroundIn Australia, the demand for foot and ankle orthopaedic services in public health settings currently outweighs capacity. Introducing experienced allied health professionals into orthopaedic units to initiate the triage, assessment and management of patients has been proposed to help meet demand. The aim of this study was to evaluate the effect of introducing a podiatry-led assessment service in a public hospital orthopaedic unit. The outcomes of interest were determining: the proportion of patients discharged without requiring an orthopaedic appointment, agreement in diagnosis between the patient referral and the assessing podiatrist, the proportion of foot and ankle conditions presenting to the service, and the proportion of each condition to require an orthopaedic appointment.MethodsThis study audited the first 100 patients to receive an appointment at a new podiatry-led assessment service. The podiatrist triaged ‘Category 3’ referrals consisting of musculoskeletal foot and ankle conditions and appointments were provided for those considered likely to benefit from non-surgical management. Following assessment, patients were referred to an appropriate healthcare professional or were discharged. At the initial appointment or following a period of care, patients were discharged if non-surgical management was successful, surgery was not indicated, patients did not want surgery, and if patient’s failed to attend their appointments. All other patients were referred for an orthopaedic consultation as indicated.ResultsNinety-five of the 100 patients (69 females and 31 males; mean age 51.9, SD 16.4 years) attended their appointment at the podiatry-led assessment service. The 95 referrals contained a total of 107 diagnoses, of which the podiatrist agreed with the diagnosis stated on the referral in 56 cases (Kappa =0.49, SE = 0.05). Overall, 34 of the 100 patients were referred to an orthopaedic surgeon and the remaining 66 patients were discharged from the orthopaedic waiting list without requiring an orthopaedic consultation.ConclusionsTwo-thirds of patients who had an appointment at the podiatry-led assessment service were discharged without requiring a surgical consultation. The introduction of a podiatry-led service assists with timely provision of patient care and ensures those with the greatest need for orthopaedic surgery have improved access to specialist care.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Evaluating the outcomes of a podiatry‐led assessment service in a public hospital orthopaedic unit

Bonanno

Medica

Tan

et al. 2014

Journal of Foot and Ankle Research

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“…To date, despite efforts to ensure that well-trained staff are appropriately appointed to an increasing number of ESP physiotherapy positions, and the potential for these positions to relieve medical staff of more routine activities,14,16,17 there is only a small amount of ongoing funding for this in this health care facility. Thus, new positions are generally funded on short-term bases that are rarely sustainable, may not attract the right people to the position, and may not allow for appropriate research and evaluation strategies to be developed.…”

Section: Resultsmentioning

confidence: 99%

“…ESP physiotherapy is a relatively new workforce initiative in Australia, adapted from UK experiences to address local/institutional needs, such as doctor shortages, long waiting lists, and/or long waiting times 14–18. Like any new business initiative, introducing ESP physiotherapy services requires a credible driver (ie, why do it?)…”

Section: Introductionmentioning

confidence: 99%

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

Morris¹,

Grimmer²,

Gilmore³

et al. 2014

JMDH

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Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

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“…Functions and procedures such as admission of patients requiring inpatient care; requesting and interpreting complex radiological imaging; and surgical debridement are currently beyond the scope of practice for podiatrists employed in the public health system in Australia. Internationally, there are many examples of professions seeking and acquiring pathways to extended scope of practice [15-18]. The adoption of the nurse practitioner model is one such example where nurses have successfully acquired an extension to their scope of practice through the acquisition of higher academic qualifications and vocational training [19].…”

Section: Introductionmentioning

confidence: 99%

Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high‐risk foot coordinator in an acute foundation trust hospital

Cichero

Bower

Walsh

et al. 2013

Journal of Foot and Ankle Research

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BackgroundTo enhance the acute management of people with diabetic foot disease requiring admission, an extended scope of practice, podiatric high-risk foot coordinator position, was established at the Great Western Hospital, Swindon in 2010. The focus of this new role was to facilitate more efficient and timely management of people with complex diabetic foot disease. The aim of this project was to investigate the impact of the podiatric high-risk foot coordinator role on length of stay, rate of re-admission and bed cost.MethodThis study evaluated the difference in length of stay and rate of re-admission between an 11- month pre-pilot period (November 2008 to October 2009) and a 10-month pilot period (August 2010 to June 2011). The estimated difference in bed cost between the pre-pilot and pilot audits was also calculated. Inclusion criteria were restricted to inpatients admitted with a diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause for admission. Eligible records were retrieved using ICD-10 (V9) coding via the hospital clinical audit department for the pre-pilot period and a unique database was used to source records for the pilot phase.ResultsFollowing the introduction of the podiatric high-risk foot coordinator, the average length of stay reduced from 33.7 days to 23.3 days (mean difference 10.4 days, 95% CI 0.0 to 20.8, p = 0.050). There was no statistically significant difference in re-admission rate between the two study periods, 17.2% (95% CI 12.2% to 23.9%) in the pre-pilot phase and 15.4% (95% CI 12.0% to 19.5%) in the pilot phase (p = 0.820). The extrapolated annual cost saving following the implementation of the new coordinator role was calculated to be £234,000 for the 2010/2011 year.ConclusionsThis audit found that the extended scope of practice coordinator role may have a positive impact on reducing length of stay for diabetic foot admissions. This paper advocates the role of a podiatric high-risk foot coordinator utilising an extended scope of practice model, although further research is needed.

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Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care

Cited by 13 publications

References 2 publications

Evaluating the outcomes of a podiatry‐led assessment service in a public hospital orthopaedic unit

Evaluating the outcomes of a podiatry‐led assessment service in a public hospital orthopaedic unit

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high‐risk foot coordinator in an acute foundation trust hospital

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