Schwank A1, Boger A1, Koch P2, Gisi D1
1Kantonsspital Winterthur, Institut für Physiotherapie, Winterthur, Switzerland, 2Kantonsspital Winterthur, Klinik für Orthopädie und Traumatologie, Winterthur, Switzerland
Background: Advanced roles in physiotherapy are fostered by numerous factors; medical specialist shortage, increasing costs in health care, continuous specialization and academization of the physiotherapy profession. In several health care systems around the globe, the development of advanced clinical practitioners in physiotherapy showed beneficial effects. In Switzerland, awareness increased for the benefits of enhanced interprofessional work and task-shifts from medical doctors to physiotherapists in treatment quality for patients (Künzi et al., 2013). Improvement in job resilience and commitment were additional benefits (Körner et al., 2015).
Due to their given structures of multiprofessional work; acute care hospitals seem predestinated to develop new roles in physiotherapy. In recognition of these findings, the hospital “Kantonsspital Winterthur” (KSW) launched a task-shifting project.f The perioperative management of rotator cuff repair (RCR) and anterior cruciate ligament reconstruction (ACLR) project, initiated in May 2018.
Purpose: To shift the perioperative consultations of RCR and ACLR from orthopaedic surgeon to the physiotherapist to improve efficiency of the surgeon and cost-effectiveness (of the hospital).
To enlarge the competencies of the specialised physiotherapists in orthopaedics.
Methods: The project was divided into two phases:
Primary project phase (experimental phase) emphasised a person-oriented approach, physiotherapy specialists for upper and lower limb and corresponding head of orthopaedic surgery were in charge of testing and developing new tasks. Secondary project phase (institutionalization phase) the executive board of the hospital adjusted the standard operating procedures (SOP) to progress from person-oriented project phase to operationally functioning standard-care.
Results: Analysis of successful achieved task-shift from orthopaedic surgeons to physiotherapists detected two main requirements:
First, daily physiotherapy practice met high-quality standards, which were recognized and valued by surgeons, and identified physiotherapists as potential task-shift partners. Second, executive board and hospital leadership fully accepted the proposed task-shift and advanced roles for physiotherapists, to eliminate potential disturbing factors.
Conclusion(s): The clarification and distribution of the new roles within the interprofessional team represented a key element for the successful implementation of the task-shift project. Moreover, the adjustment of the hospital's SOPs was crucial to enable the sustainability of this new development in Swiss physiotherapy practice.
Future projects will evaluate the cost-effectiveness of the novel task-shift model at KSW. A grant by the Swiss federal office of public health was confirmed in September 2018.
Implications: Swiss task-shifting pioneers and their collaborating stakeholders; the associations of physiotherapy and orthopaedic surgery and the universities should focus on achieving consensus regarding qualification criteria for this novel role. Access in advanced orthopaedic physiotherapy and new standards for education, practice, and legal policy including reimbursement are required.
Keywords: enhanced roles, physiotherapy development, health care resources
Funding acknowledgements: Internal hospital financing for the presented project. future study of cost-effectiveness funded by the Swiss federal office of public health.
Due to their given structures of multiprofessional work; acute care hospitals seem predestinated to develop new roles in physiotherapy. In recognition of these findings, the hospital “Kantonsspital Winterthur” (KSW) launched a task-shifting project.f The perioperative management of rotator cuff repair (RCR) and anterior cruciate ligament reconstruction (ACLR) project, initiated in May 2018.
Purpose: To shift the perioperative consultations of RCR and ACLR from orthopaedic surgeon to the physiotherapist to improve efficiency of the surgeon and cost-effectiveness (of the hospital).
To enlarge the competencies of the specialised physiotherapists in orthopaedics.
Methods: The project was divided into two phases:
Primary project phase (experimental phase) emphasised a person-oriented approach, physiotherapy specialists for upper and lower limb and corresponding head of orthopaedic surgery were in charge of testing and developing new tasks. Secondary project phase (institutionalization phase) the executive board of the hospital adjusted the standard operating procedures (SOP) to progress from person-oriented project phase to operationally functioning standard-care.
Results: Analysis of successful achieved task-shift from orthopaedic surgeons to physiotherapists detected two main requirements:
First, daily physiotherapy practice met high-quality standards, which were recognized and valued by surgeons, and identified physiotherapists as potential task-shift partners. Second, executive board and hospital leadership fully accepted the proposed task-shift and advanced roles for physiotherapists, to eliminate potential disturbing factors.
Conclusion(s): The clarification and distribution of the new roles within the interprofessional team represented a key element for the successful implementation of the task-shift project. Moreover, the adjustment of the hospital's SOPs was crucial to enable the sustainability of this new development in Swiss physiotherapy practice.
Future projects will evaluate the cost-effectiveness of the novel task-shift model at KSW. A grant by the Swiss federal office of public health was confirmed in September 2018.
Implications: Swiss task-shifting pioneers and their collaborating stakeholders; the associations of physiotherapy and orthopaedic surgery and the universities should focus on achieving consensus regarding qualification criteria for this novel role. Access in advanced orthopaedic physiotherapy and new standards for education, practice, and legal policy including reimbursement are required.
Keywords: enhanced roles, physiotherapy development, health care resources
Funding acknowledgements: Internal hospital financing for the presented project. future study of cost-effectiveness funded by the Swiss federal office of public health.
Topic: Orthopaedics; Primary health care; Orthopaedics
Ethics approval required: No
Institution: Kantonsspital Winterthur (KSW)
Ethics committee: Internal ethics committee of KSW
Reason not required: No personal patient data was involved.
All authors, affiliations and abstracts have been published as submitted.
