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Meyer K1, Ionescu D2, Meier Zürcher C1
1University Hospital Zurich, Physiotherapy Occupational Therapy, Zurich, Switzerland, 2University Hospital Zurich, Nursing and Allied Health Professions Office, Zurich, Switzerland
Background: In Swiss hospitals, physiotherapy requires a medical prescription. However, in complex organizations like university hospitals, the initiation of physiotherapy is often delayed due to inaccurate indications and/or missing/incorrect prescriptions. To avoid this problem and to ensure early as well as adequate treatment for patients, physiotherapists with extended role profiles should assume more responsibility by defining the indication for physiotherapy and prescribing treatment. This is already the case in different countries where Advanced Practice Physiotherapy contributes to an improved treatment process.
Purpose: The aim of this project was to optimize the process of indication and prescription by extending physiotherapistsˊ competences.
Methods: To explore the existing problems, we performed six focus group interviews with physiotherapists, nurses and physicians. In a second step, we developed a questionnaire to identify the amount of incorrect prescriptions. Based on the results of the questionnaire, we defined an adapted prescription process and implemented it in two clinics. Three months before and three months after introducing the adapted process, we performed an evaluation by measuring patient length of stay, time to organize prescriptions, beginning of physiotherapy and number of patients not receiving necessary physiotherapy. We analyzed the results with descriptive statistics and non-parametric tests.
Results: In the adapted process, physiotherapists triaged patients with defined diagnoses after attending daily morning meetings of physicians or on the basis of data in the clinical information system. Therefore, a prescription was not required. To meet the Swiss legal framework, we elaborated a written agreement between physicians and physiotherapists since physicians are responsible for decisions concerning physiotherapy. Patients with defined diagnoses (“myocardial infarction”, “transcatheter aortic valve implantation”, “lung resection”, “lung transplantation”, “diverse lung operations”) benefited from the adapted process. For patients with other diagnoses, we maintained the previous process.
During five working days, the average time to organize prescriptions diminished significantly for physicians (p=0.001) from 10 [10-20] to 0 [0-5] minutes and for nurses from 10 [5-15]) to 5 [0-10] minutes (median [IQR]) (p=0.02). Patient length of stay decreased significantly from 10 [8-15] to 8 [5-12] days (median [IQR]) in the Thoracic Surgery Clinic (THO) (p=0.001) and from 7 [5-11] to 5 [3-9] days (median [IQR]) in the Cardiology Centre (CAR) (p=0.02). Time until the beginning of physiotherapy did not change significantly - one day in the THO and two days in the CAR (median). The number of patients receiving physiotherapy in the CAR increased significantly from 49 to 95 (p=0.005). These patients had an indication for physiotherapy. The percentage of patients not receiving necessary physiotherapy in the THO also diminished significantly from 10.6% to 0.8% (p=0.001).
Conclusion(s): Time savings, reduced length of stay and a smaller number of patients not receiving necessary physiotherapy indicate that the project significantly improved the process of indication and prescription. More patients with an indication received physiotherapy. Therapists reported positive experiences.
Implications: Extended competences of physiotherapists may contribute to early treatment and less
non-treated patients with indication for physiotherapy. Our results could set an impulse to extend therapistsˊ role profile in Switzerland.
Keywords: extended roles, indication for physiotherapy, quality management
Funding acknowledgements: This work was unfunded. We would like to thank the University Hospital Zurich for providing time resources.
Purpose: The aim of this project was to optimize the process of indication and prescription by extending physiotherapistsˊ competences.
Methods: To explore the existing problems, we performed six focus group interviews with physiotherapists, nurses and physicians. In a second step, we developed a questionnaire to identify the amount of incorrect prescriptions. Based on the results of the questionnaire, we defined an adapted prescription process and implemented it in two clinics. Three months before and three months after introducing the adapted process, we performed an evaluation by measuring patient length of stay, time to organize prescriptions, beginning of physiotherapy and number of patients not receiving necessary physiotherapy. We analyzed the results with descriptive statistics and non-parametric tests.
Results: In the adapted process, physiotherapists triaged patients with defined diagnoses after attending daily morning meetings of physicians or on the basis of data in the clinical information system. Therefore, a prescription was not required. To meet the Swiss legal framework, we elaborated a written agreement between physicians and physiotherapists since physicians are responsible for decisions concerning physiotherapy. Patients with defined diagnoses (“myocardial infarction”, “transcatheter aortic valve implantation”, “lung resection”, “lung transplantation”, “diverse lung operations”) benefited from the adapted process. For patients with other diagnoses, we maintained the previous process.
During five working days, the average time to organize prescriptions diminished significantly for physicians (p=0.001) from 10 [10-20] to 0 [0-5] minutes and for nurses from 10 [5-15]) to 5 [0-10] minutes (median [IQR]) (p=0.02). Patient length of stay decreased significantly from 10 [8-15] to 8 [5-12] days (median [IQR]) in the Thoracic Surgery Clinic (THO) (p=0.001) and from 7 [5-11] to 5 [3-9] days (median [IQR]) in the Cardiology Centre (CAR) (p=0.02). Time until the beginning of physiotherapy did not change significantly - one day in the THO and two days in the CAR (median). The number of patients receiving physiotherapy in the CAR increased significantly from 49 to 95 (p=0.005). These patients had an indication for physiotherapy. The percentage of patients not receiving necessary physiotherapy in the THO also diminished significantly from 10.6% to 0.8% (p=0.001).
Conclusion(s): Time savings, reduced length of stay and a smaller number of patients not receiving necessary physiotherapy indicate that the project significantly improved the process of indication and prescription. More patients with an indication received physiotherapy. Therapists reported positive experiences.
Implications: Extended competences of physiotherapists may contribute to early treatment and less
non-treated patients with indication for physiotherapy. Our results could set an impulse to extend therapistsˊ role profile in Switzerland.
Keywords: extended roles, indication for physiotherapy, quality management
Funding acknowledgements: This work was unfunded. We would like to thank the University Hospital Zurich for providing time resources.
Topic: Professional issues; Service delivery/emerging roles
Ethics approval required: Yes
Institution: BASEC (Business Administration System for Ethics Committees), Swissethics, Switzerland
Ethics committee: Kantonale Ethikkommission Zürich, Request-2016-00265
Ethics number: The project is not subject to Human Research Act
All authors, affiliations and abstracts have been published as submitted.
