G279(P) Opt in: paediatric physiotherapy management of the acute soft tissue injury

Abstract

AimOptimal treatment and rehabilitation for paediatric soft tissue injury is not widely discussed in literature therefore determining optimal management is based on each individual patient needs. Experimental and clinical studies demonstrate that early, controlled mobilisation is superior to immobilisation for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management. Children with soft tissue injury presenting at the emergency department are routinely referred to Physiotherapy. Referrals are screened to establish their Physiotherapy needs and families were called to appoint. This was a timely process therefore a decision was made to redesign our service. Method All children who attended emergency department with a soft tissue injury were issued with a Physiotherapy Opt In letter to enable families to contact our department within a 48 hour period for an urgent physiotherapy appointment. A pathway was developed to access Physiotherapy service for in and out of hours. Education was provided to all minor injury staff on accessing our service and the management of the acute soft tissue injury. An audit was carried on the uptake over a 5 month period.ResultThe audit revealed 36%–55% uptake of referrals that were opting in to Physiotherapy following a visit to the emergency department with a soft tissue injury. Numbers of referrals varied significantly month to month from 17- 48 in one month. Most referrals were received from the weekend and out of hours. As a result of this we set up daily emergency return clinics to cope with service demand.ConclusionTo date we do not know if these numbers replicate our previous way of working on an ‘ad hoc’ basis which is a limitation to the audit. However, of those patients who have not contacted for Physiotherapy appointment, they have not represented with musculoskeletal symptoms later due to the change to our service or deterioration of their symptoms. Staff felt their time was better managed to allocate to other duties and patients. A satisfaction survey to parents may be a way to evaluate its ease of use. This service change has shown benefit to both staff and patient to allow timely management of the soft tissue injury and preventing chronic symptoms.