Lathia C.1, Kebbie I.2, Beynon F.1
1King's Sierra Leone Partnership, King's Centre for Global Health, King's College London and King's Health Partners, London, United Kingdom, 2Connaught Hospital, Ministry of Health and Sanitation, Physiotherapy, Freetown, Sierra Leone
Background: In Sierra Leone, little is known about physiotherapy needs but the high prevalence of health problems such as trauma, amputation, stroke, and lung disease suggest they are likely to be significant. There are only two qualified physiotherapists working in the Sierra Leone government health system.
Purpose: The primary objective was to assess the current need for physiotherapy among inpatients at Connaught Hospital, Freetown, and the status of referrals according to diagnosis and complications that may be preventable with early input. The aim is to use this data to set priorities for quality improvement interventions.
Methods: A cross-sectional case note review of inpatients was carried out to evaluate physiotherapy needs by assessing the individuals need for and referral to physiotherapy based on basic clinical information, diagnosis and complications. Anonymised data was collected ward-by-ward from 30th August 2016 to 14th September 2016. No formal referral process was highlighted; therefore, a referral form was created and implemented. Data was recollected on 21st and 22nd October 2016. Analysis was conducted using Stata 13.1.
Results: Physiotherapy needs were identified for 167 (47.9%) of 349 patient notes reviewed. The majority (87.4%) were adults and sex distribution was equal (49.7% women). Medical patients constituted 50.9% of patients, trauma 28.1% and surgery 21.0%. Only 38 (22.8%) of those with needs were referred to physiotherapy. 27.1% of medical and 27.7% of trauma patients with needs were referred compared to only 5.7% of surgical patients with needs were referred. Between subspecialties there was further divergence; 57.6% of medical neurology and 60% of head/spine trauma were referred, whereas, only 20.7% of orthopaedic trauma/amputations and no respiratory referrals were made. Median time from admission to referral was 10 days (interquartile range (IQR) 5-19). 78.9% were seen within 24 hours, 13.2% were seen from 24 hrs to 1 week and 7.9% were not seen. 32.3% of participants had complications; pressure sores being most common, followed by chest infections. Complications were more common with increasing delay to referral, median 21 days (IQR) 12-24. An increase was observed in referrals following the introduction of the referral form (increase of 18.9% trauma, 8.3% surgery and 0.4% medical referrals); however, this did not reach statistical significance. Of those referred 84.2% were seen pre intervention compared to 100% post-intervention.
Conclusion(s): There is an important, unmet need for physiotherapy with a lack of referrals among inpatients at Connaught Hospital. Whilst referrals are low between all specialties, respiratory illness and orthopaedic trauma were areas of particular concern. Complications were common, particularly among patients referred late. An increase in referrals was seen following the introduction of a referral process.
Implications: This evaluation has highlighted the need for improvements in recognition, referral and treatment of physiotherapy needs in Connaught Hospitals inpatients. Interventions are planned to train ward physiotherapy link nurses in recognition of needs, manual handling and interventions to prevent common complications. A re-evaluation will then be undertaken to assess the impact of interventions. Additionally, this evaluation has reinforced the urgent need for investment in neglected physiotherapy services in low-income countries, such as, Sierra Leone.
Funding acknowledgements: This work was carried out unfunded.
Topic: Globalisation: health systems, policies & strategies
Ethics approval: This was a baseline assessment for a quality improvement project, therefore, approved by hospital management. All patient data was anonymised.
All authors, affiliations and abstracts have been published as submitted.
