The impact of increased weekend physiotherapy service provision in critical care: a mixed methods study

Abstract

Background: At the hospital studied, weekend physiotherapy (WEPT) is routinely provided and in 2013 WEPT was increased from one (PRE) to three (POST) physiotherapists (PTs) to cover intensive care and ward patients. Aims: (1) To evaluate the impact of increased WEPT on patient volumes, treatments provided and conditions treated in critical care and wards; and (2) to understand the PTs’ perspectives on the new coverage model. Methods: A mixed methods design was utilized. The quantitative component consisted of retrospective document reviews of all weekend patients treated January 1–May 5 (PRE) and May 11–December 31 (POST). The qualitative component used a questionnaire to collect staff feedback. PRE–POST comparisons were conducted using χ² or Mann–Whitney U tests. Results: Significant (p?=?0.00) increases POST were seen in number of patients treated, number of mobility treatments provided and number of post-surgical patients seen in both clinical areas. The majority of survey respondents reported feeling adequately trained, but had concerns regarding the impact of increased WEPT on work-life balance. Conclusion: PTs perceived enhanced service was beneficial for continuity of weekday care and improved patient function. Future studies need to focus on measuring the effect of increased weekend provision on outcomes, preventing complications and length of stay.     

The provision of racially aware healthcare services in prisons

In a report published in 2005 the Inspectorate of Prisons explored the fact that many black and minority ethnic (BME) prisoners have poor perceptions of their treatment in all areas of prison life. It also attempted to identify barriers that still exist to delivering race equality in prisons and examined the extent to which prison healthcare departments are providing a racially aware health service that assesses and meets individual needs.     

Information provision services in dementia care

There are currently 25 million people with dementia worldwide, and this number is rising. Dementia has been highlighted as a major priority for health care and research because of the enormous economical and health burden associated with it. Consultations with people with dementia and carers have highlighted that timely well-targeted information services are a key priority for enabling them to 'live well with dementia'. Despite this, the evidence base for the optimal design and delivery of an information provision service is limited. Findings from randomised controlled trials and other studies have indicated that information provision does confer some benefit in carer outcomes and in the symptoms and well-being of people with dementia. However, there is limited understanding of the optimal design of such a service because of the variety of approaches that have been evaluated, the wide range of settings and locations and the lack of a clear conceptual framework. The existing evidence base supports the importance of an optimised information provision service and strongly indicates the need for a large-scale RCT to identify the most effective and cost-effective design for people with dementia and their carers.     

The value of accident and emergency based physiotherapy services.

OBJECTIVE--To investigate whether accident and emergency (A&E) department based physiotherapy has any advantages over its traditional counterpart in providing treatment for soft tissue injuries. METHODS--Two A&E departments were compared: hospital A had a traditional physiotherapy service, while hospital B had A&E based physiotherapy. Groups of adult patients from these two hospitals were compared over a one month period. Data on injuries, number of physiotherapy treatment sessions, and outcome were recorded. RESULTS--There were 27 referrals for physiotherapy in hospital A during the study period (1.17% of attendances) and 111 referrals in hospital B (4.03%) (P < 0.001). The waiting time for physiotherapy was significantly less at hospital B (3 v 7 d, P < 0.001) despite a far greater number of patients referred. Non-referral at the hospital with the traditional service was due to a perceived long waiting time by the referring doctors. Patients with longer waiting times were found to be less likely to attend their first appointment, and this was therefore more common in the hospital with the traditional service (39.5% v 9.8%). CONCLUSIONS--An A&E based physiotherapy service results in a greater referral rate and a shortened time between referral and first treatment. Further research is needed to evaluate and compare long terms outcomes following treatment by both types of physiotherapy service.     

The provision of leg ulcer services by practice nurses

As part of their implementation programme of leg ulcer guidelines, the group conducted a study of the caseload and attitudes and training of practice nurses with relation to leg ulcer management. They begin by outlining the prevalence and treatment methods of leg ulcers, then outline their study and put forward their resulting recommendations.     

After-hour physiotherapy services in a tertiary general hospital

The aims of the present study were to describe the after-hour physiotherapy services in a tertiary general hospital, the patients and their demographics, and to determine which independent variables would predict physiotherapists' referrals to after-hour physiotherapy. A retrospective record review from April 1, 2004, to April 30, 2005, identified 992 patients (mean age 63.8 years; 95% confidence interval [CI] 62.6–65.0 years) who were either referred by daytime physiotherapists (68%) or referred by medical practitioners for urgent attendance after hours (32%). Pneumonia was formally diagnosed medically in 20% (n=197) of the patients. Of all the patients who had surgery, upper abdominal or thoracic incisions formed the majority (61%; n=236). Whether patients had upper abdominal/thoracic surgery (estimated odds ratio 3.4; 95% CI 2.3–4.9) and the presence of pneumonia (2.8; 95% CI 1.9–4.2) were two independent factors identified from a logistic regression model predicting daytime physiotherapists’ referral of patients to after-hour service. This model correctly predicted 65.5% of the cases. Most patients were seen for mucociliary clearance. Referral behaviour by physiotherapists reflects the basis of their clinical decision making and has implications for practice, training, and further research.     

Counselling provision in specialist drug treatment services

Background Counselling is one of the most common treatment options in drug services, and recent research has convincingly demonstrated its effectiveness if certain quality parameters regarding intensity and qualifications of those providing it are observed. However, there is a remarkable paucity of literature on the nature of counselling provision in UK drug treatment.

Aims To describe the extent and nature of counselling provision in UK drug treatment services.

Method A national survey of specialist drug services in England and Wales was carried out, and information was obtained from 326 services.

Results Levels of counselling provision were very similar in nonstatutory, community‐based, residential day care and statutory, community‐based services (around 90%), with slightly lower levels in inpatient services (78%, difference not significant). In the majority of services (74%), individual sessions were provided by drug workers without counselling accreditation. In 32% of agencies, counselling was provided only by drug workers, whereas 36% of agencies employed both drug workers and accredited counsellors. In 17% of agencies, sessions were run by accredited counsellors only. Volunteers without formal training provided one‐to‐one sessions in 27% of agencies, mostly in agencies also employing counsellors and drug workers. Most agencies (66%) operated a schedule of weekly sessions; 12% of agencies offered fortnightly or less frequent sessions, whereas 15% of agencies offered several sessions a week. More than three‐quarters of all sessions were scheduled to last between 50 and 60?minutes.

Conclusion Typically, counselling is provided on a weekly to fortnightly basis by drug workers without formal counselling qualifications. In‐depth research is needed to examine whether and how sessions provided by drug workers differ from sessions provided by counsellors, as past research has only demonstrated the effectiveness of counselling in studies using highly trained counselling staff.     

Effectiveness of provision of outdoor mobility services and devices in The Netherlands

OBJECTIVE: To answer the following questions: What are the problems encountered by people with outdoor mobility disabilities? What solutions are being offered to them in The Netherlands? How effective are these solutions? How responsive is the IPPA instrument (Individually Prioritized Problem Assessment)? DESIGN: Analysing the results of a follow-up study using the IPPA instrument. SETTING: The Dutch Service for the Disabled Act (SDA, in Dutch: WVG) provision system. This act is responsible for the provision of mobility aids and home adaptations. SUBJECTS: Fifty-nine people with outdoor mobility disabilities. INTERVENTIONS: The provision of outdoor mobility service and devices. MAIN OUTCOME MEASURES: Effectiveness of provisions as measured using IPPA (i.e., the degree to which activities have become less difficult to perform), effect size of IPPA with this intervention. RESULTS: Problems identified by clients are very diverse and specific but can be classified fairly well on the basis of the International Classification of Functioning, Disability and Health (ICF); in the main, the solutions they are provided with are very similar and generic. Effectiveness is excellent at a group level, but insufficient for some at an individual level. The IPPA instrument is highly responsive in this setting. Most mobility problems respondents identified, although very individual and specific, were related to shopping, social visits or leisure activities. These specific sets of problems were solved using 'standard', generic solutions. CONCLUSIONS: The Dutch provision system should be more 'demand oriented' and less 'supply oriented'. IPPA turns out to be a useful, structured and individual-oriented method to evaluate service delivery.