Kelly M1, McCreesh K2, Higgins A1, Murphy A3
1Mercy University Hospital, Physiotherapy Department, Cork, Ireland, 2University of Limerick, School of Allied Health, Limerick, Ireland, 3Mercy University Hospital, Emergency Department, Cork, Ireland

Background: Emergency departments (EDs) are one of the main providers of treatment for musculoskeletal conditions, with early access to physiotherapy strongly advocated for within the Irish Health Service Executive National Emergency Medicine Programme (2012). However, timely access is a longstanding issue, resulting in increased non-attendance rates. In an attempt to meet these challenges, a physiotherapy-led telephone assessment and advice service was proposed, rather than the usual face-to-face care pathway. This model of care has been established across many regions in the UK and appears to be as clinically effective as face-to-face physiotherapy, with shorter waiting times and reductions in non-attendance rates also illustrated (Salisbury et al., 2013). However, to date, this model of care has yet to be evaluated within either the Irish healthcare system or physiotherapy ED setting.

Purpose: The aim of this study was to evaluate the impact of a telephone assessment and advice service on waiting times, non-attendance rates and service user satisfaction. A secondary aim was to investigate the clinical effectivenss of this care pathway, compared to usual care.

Methods: For this single-site cross-sectional three-month pilot, adults (aged ≥ 18 years of age) were recruited if following their attendance at the ED at Mercy University Hospital Cork, Ireland, physiotherapy was deemed appropriate. The first treatment option was a telephone assessment and advice service, while the alternative was a face-to-face consultation. The primary outcome measures were non-attendance rates (%), wait time to first contact (days), number of contacts and satisfaction data. Satisfaction data was collected using a satisfaction survey adapted from the General Practice Assessment Questionnaire, which has been utilised previously (Salisbury et al., 2013). To characterize clinical outcome on the last physiotherapy appointment, a seven point global improvement scale was utilised. Data analysis was descriptive using Microsoft Excel.

Results: Ninety four patients were referred to the telephone assessment and advice service, while twenty five patients have been referred to usual care. Of those that have opted for the telephone assessment and advice service, 34% (n=32) made contact with the service. These patients had fewer appointments (average 2.16 v 2.6), a shorter wait time (average 6.19 v 28.8 days) and reduced non-attendance rates (5.9% v 20.9%). Satisfaction survey data is currently being collected with a greater percentage in the usual care group (n=5) either fairly or highly satisfied, compared to the telephone assessment and advice service group (n=9) (100% v 66.7%). The preliminary global improvement score data suggests a higher percentage in the usual care group (n=5) were either slightly, much or very much better, compared to the telephone assessment and advice group (n=11) (100% v 63.6%).

Conclusion(s): This quality improvement project reduced non-attendances and provided faster access to ED physiotherapy, compared to usual care. This novel care pathway was broadly acceptable to service users. However, a large scale prospective study is warranted to confirm these findings.

Implications: This pilot study highlights the potential benefits of a telephone assessment and advice service within an ED physiotherapy setting and may encourage further investigation of innovative methods of physiotherapy care delivery in the future.

Keywords: Musculoskeletal, non-attendance, waiting times

Funding acknowledgements: Nil

Topic: Musculoskeletal

Ethics approval required: Yes
Institution: University College Cork
Ethics committee: Clinical Research Ethics Committee of the Cork Teaching Hospitals
Ethics number: ECM4(b)05/06/18

All authors, affiliations and abstracts have been published as submitted.

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