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