ABSTRACT
Keywords: Soft tissue trauma, Advanced Practice Physiotherapist, Fracture Clinic Purpose: A large amount of patients were identified in Fracture Clinic with soft tissue trauma who did not necessarily need to see a doctor. We proposed that we could reduced the demands on doctors in Fracture Clinic and the foot-fall through the hospital, whilst improving patient outcomes and patient satisfaction by having these patients seen instead in an advanced practice physiotherapist-led STTC. Aims of the pilot: 1. Reduce the number of patients in Fracture Clinic requiring medical review 2. Standardise pathways of care 3. Provide patients with earlier specialised physiotherapy management 4. Maintain or improve outcomes and patient satisfaction Methods: A quality improvement approach was used with an Action Research Methodology. Results: Less patients with Soft tissue trauma required medical review. Reduced patient foot-fall through the hospital (59% of patients discharged at first contact compared to 35% of patients in Fracture Clinic). Management pathways for patients with soft tissue trauma were standardised. Patients received early specialist physiotherapy management. Also reduced number of referrals to physiotherapy and a reduced average number of subsequent physiotherapy follow-up appointments. We received outstanding patient satisfaction (95% rated extremely likely to recommend the service to friends and family;97/100 achieved on the VSQ-9 satisfaction questionnaire) Conclusion(s): The Soft Tissue Trauma Clinic utilises expert clinicians who provide a highly effective and cost-efficient service that reduces demand on Fracture Clinic whilst delivering excellent patient outcomes and satisfaction. Depending on funding, we are hoping the service can be made substantive, and then expanded to be included in the Trust's Trauma management pathway. Impact: We’ve demonstrated that patients with Soft tissue trauma can be successfully managed without needing to see a doctor in Fracture Clinic. Adopting an APP led-soft tissue trauma clinic could aid the post-COVID Orthopaedic Recovery Plan by releasing a Registrar from Fracture clinic to do other activities, such as elective orthopaedic clinics or additional theatre lists. We were able to reduce the footfall through the hospital. More patients were discharged at first contact in the STTC with fewer requiring additional follow-up appointments because patients were seeing the right person at the right time. 59% of patients were appropriately discharge at their first attendance in the STTC compared to 35% in Fracture clinic. We managed to agree with the Orthopaedic team Standardised care pathways for patients with STT. In line with the NHS Long-term plan, if we can standardise care pathways we can:- Reduced unwarranted variation which in-turn will reduce variations in outcomes and inequalities. - We can ensure an evidenced base and best practice model is followed as suggested by the ‘GIRFT’ as opposed to research literature and anecdotal evidence that suggests a lot of variation in patient management by current fracture clinic services. We were able to provide patients with earlier specialist physiotherapy management. We know the earlier we can provide suitable management advice we are more likely to improve a patient's function and their return to work, reduce patient anxiety, and reduce long-term pain and disability. We also reduced the length of a patient's rehabilitation and need for further physiotherapy. Funding acknowledgements: Not funded