To optimise and streamline care within a large Public Hospital Fracture Clinic by delivering an effective and efficient service meeting the needs of the community, reducing time to care, improving clinician and patient experience.
A mixed method approach was applied using the Agency for Clinical Innovation’s Clinical Redesign Methodology. Diagnostic data collection included retrospective file audits, routinely collected data from the electronic records, process mapping, observational studies and qualitative surveys with patients and clinicians. Feedback from Thirty-four clinicians (Allied Health, Nursing, and Orthopaedic Surgeons) and 225 patients/carers, were captured. Information was themed and identifying five focus areas for solution design workshops. This resulted in implementation of a new Model of Care, including triage guidelines, physiotherapy-led clinics, e-referrals and improved patient information.
Three main solutions were implemented, which included a pathways to care model. Here it was identified that patients could be allocated into clinical streams according to injury type, severity, and treatment required. This resulted in the creation of a new Model of Care (MoC) with two Physiotherapy Led Clinical Streams: Cast removals clinic; and Physiotherapy Led Fracture Clinic. This change allowed the Physiotherapist to operate at their full scope of practice.
Early results since implementation include:
- a decrease in median total patient time in clinic per episode of care from 155 minutes to 125 minutes(p0.0001); (specifically to 23 minutes (p0.0001) for cast removals clinic and 87 minutes(p0.0001) for physiotherapist led)
- improved patient experience, baseline: achieving one benchmark out of 13 to achieving six benchmarks
- staff satisfaction improved from 39% to 78%.
Since the introduction of this approach, the Physiotherapy led clinics has reduced Orthopaedics’ OOS by 22%. Further evaluation is planned at six months post implementation.
Early results support the implementation of our new Model of Care in particular top of scope of practice roles for physiotherapists. This has reduced the number of patients for Orthopaedics, clinic session times, and improved patient and staff experience. These changes came about because of the application of strong project management, an implementation framework, and a systematic approach to changing practice.
Physiotherapists can play a leading role in Fracture Clinics, with a more cost-effective approach to providing care and utilising orthopaedic surgeons when clinically appropriate. There are opportunities to scale this Model of Care across other Fracture Clinics and similar outpatient services.
Fracture
Scope of Practice
