A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

Abstract BackgroundIn response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionA telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

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A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study

Archives of Physiotherapy ◽

10.1186/s40945-020-00098-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marie Kelly ◽

Anna Higgins ◽

Adrian Murphy ◽

Karen McCreesh

Keyword(s):

Cohort Study ◽

Quality Improvement ◽

Usual Care ◽

Wait Time ◽

Single Site ◽

Site Quality ◽

Attendance Rates ◽

Improvement Project ◽

Face To Face ◽

Advice Service

Abstract Background In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. Methods This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. Results Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. Conclusion A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

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A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

10.21203/rs.3.rs-69131/v2 ◽

2020 ◽

Author(s):

Marie Kelly ◽

Anna Higgins ◽

Adrian Murphy ◽

McCreesh

Keyword(s):

Cohort Study ◽

Usual Care ◽

User Satisfaction ◽

Service User ◽

Wait Time ◽

Single Site ◽

Site Quality ◽

Attendance Rates ◽

Face To Face ◽

Advice Service

Abstract .BackgroundIn response to issues with timely access for musculoskeletal physiotherapy, telephone assessment and advice services have been evaluated in primary care settings. It is unclear whether this service model can reduce non-attendance rates and wait times and for Emergency Department (ED) physiotherapy, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site cohort study that compares data on non-attendance rates, wait time to first physiotherapy contact and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on non-attendance rates and wait time was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionGiven the faster access to ED physiotherapy, without compromising on service user satisfaction, this telephone assessment and advice service, which can be introduced rapidly, could be helpful in triaging referrals and minimising face-to-face consultations in line with COVID-19 recommendations. However, a large scale study is warranted to confirm these findings.

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An evaluation of the effectiveness of a telephone assessment and advice service within an ED Physiotherapy clinic: A single-site cohort study

10.21203/rs.3.rs-69131/v1 ◽

2020 ◽

Author(s):

Marie Kelly ◽

Anna Higgins ◽

Adrian Murphy ◽

Karen McCreesh

Keyword(s):

Cohort Study ◽

Usual Care ◽

User Satisfaction ◽

Service User ◽

Large Scale ◽

Wait Time ◽

Single Site ◽

Attendance Rates ◽

Face To Face ◽

Advice Service

Abstract BackgroundIn response to issues with timely access for musculoskeletal physiotherapy, telephone assessment and advice services have been evaluated in primary care settings. It is unclear whether this service model can reduce wait times and non-attendance rates for Emergency Department (ED) physiotherapy, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site cohort study that compares data on non-attendance rates, wait time to first physiotherapy contact and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on non-attendance rates and wait time was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionGiven the faster access to ED physiotherapy, without compromising on service user satisfaction, this telephone assessment and advice service, which can be introduced rapidly, could be helpful in triaging referrals and minimising face-to-face consultations in line with COVID-19 recommendations. However, a large scale study is warranted to confirm these findings.

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Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2018-000427 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000427 ◽

Cited By ~ 3

Author(s):

Udaya Prabhakar Udayaraj ◽

Oliver Watson ◽

Yoav Ben-Shlomo ◽

Maria Langdon ◽

Karen Anderson ◽

...

Keyword(s):

Quality Improvement ◽

Kidney Transplant ◽

Blood Test ◽

Significant Proportion ◽

Kidney Transplant Recipients ◽

Test Quality ◽

Improvement Project ◽

Face To Face ◽

Transplant Patients ◽

Kidney Transplant Patients

Kidney transplant patients in our regional centre travel long distances to attend routine hospital follow-up appointments. Patients incur travel costs and productivity losses as well as adverse environmental impacts. A significant proportion of these patients, who may not require physical examination, could potentially be managed through telephone consultations (tele-clinic). We adopted a Quality Improvement approach with iterative Plan–Do–Study–Act (PDSA) cycles to test the introduction of a tele-clinic service. We codesigned the service with patients and developed a prototype delivery model that we then tested over two PDSA improvement ramps containing multiple PDSA cycles to embed the model into routine service delivery. Nineteen tele-clinics were held involving 168 kidney transplant patients (202 tele-consultations). 2.9% of tele-clinic patients did not attend compared with 6.9% for face-to-face appointments. Improving both blood test quality and availability for the tele-clinic was a major focus of activity during the project. Blood test quality for tele-clinics improved from 25% to 90.9%. 97.9% of survey respondents were satisfied overall with their tele-clinic, and 96.9% of the patients would recommend this to other patients. The tele-clinic saved 3527 miles of motorised travel in total. This equates to a saving of 1035 kgCO2. There were no unplanned admissions within 30 days of the tele-clinic appointment. The service provided an immediate saving of £6060 for commissioners due to reduced tele-clinic tariff negotiated locally (£30 less than face-to-face tariff). The project has shown that tele-clinics for kidney transplant patients are deliverable and well received by patients with a positive environmental impact and modest financial savings. It has the potential to be rolled out to other renal centres if a national tele-clinic tariff can be negotiated, and an integrated, appropriately reimbursed community phlebotomy system can be developed to facilitate remote monitoring of patients.

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Abstract 34: Kentucky Stroke Encounter Quality Improvement Project Statewide Collaboration to Improve Alteplase Utilization, Decrease Door to Needle Times, and Impact Outcomes: A 10 Year Review

Stroke ◽

10.1161/str.51.suppl_1.34 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kari D Moore ◽

Lynn Hundley ◽

Polly Hunt ◽

Bill Singletary ◽

Allison Merritt ◽

...

Keyword(s):

Quality Improvement ◽

Best Practices ◽

Best Practice ◽

Systems Of Care ◽

Quality Improvement Project ◽

Complication Rates ◽

Improvement Project ◽

Face To Face ◽

Data Tracking ◽

Stroke Systems Of Care

Background: Evidence shows systems change interventions improve care and outcomes for stroke patients. Geopolitical boundaries have been a barrier to improving regional systems of care. Despite efforts nationally, regionally, and locally alteplase use for ischemic stroke has remained low and door to needle (DTN) times exceeded 60 minutes. Kentucky created the Stroke Encounter Quality Improvement Project (SEQIP) in 2009 to share best practices and improve stroke systems of care across the Commonwealth. Purpose: The aim was to utilize and share best practice models among 23 SEQIP hospitals in KY to improve tPA utilization, decrease DTN times, and improve outcomes. Methods: Hospitals implemented a statewide quality improvement plan focused on identifying barriers, removing barriers, and implementing best practice strategies regarding thrombolytic therapy. Accountability was achieved with ongoing GWTG data tracking, teleconferences, and face to face meetings from January 2009 through December 2018 sharing strategies and solutions for best practice. Results: SEQIP’s participating hospitals achieved significant improvement in thrombolytic administration over 10 years. The percent of all AIS patients receiving tPA increased from 4.61% in 2009 to 8.80% in 2018 (OR=2.0, p <0.0001). Alteplase use in eligible patients arriving by 2 hours and treated by 3 hours improved from 59.6% to 88.5% (OR=5.2, p <0.0001). Alteplase use in eligible patients arriving by 3.5 hours to 4.5 hours increased from 24.9% to 55.1% (OR=5.0, p <0.0001). Median DTN times decreased from 74 minutes to 49 minutes (p<0.0001). Complication rates of symptomatic hemorrhage were consistent with NINDS data and < 6% from 2009-2018. The tPA in-hospital mortality rate in 2009 was 11.7% and by 2018, decreased to 3.6% (p=0.00016). In 2009, 28.4% of tPA patients were discharged home and by 2018, that had increased to 47.9% (p <0.00001). In 2009, 32.1% of tPA patients were able to walk independently at d/c and by 2018 had increased to 43.6% (p = 0.00359). Conclusions: Geopolitical boundaries can be overcome and collaboration can be sustained among competing hospitals through sharing of best practices to safely increase utilization of tPA in eligible patients, decrease DTN times, and improve outcomes.

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Variability in paediatric cardiac postoperative chest tube management

Cardiology in the Young ◽

10.1017/s104795111800152x ◽

2018 ◽

Vol 28 (12) ◽

pp. 1471-1474 ◽

Cited By ~ 1

Author(s):

Anne C. Taylor ◽

Katherine E. Bates ◽

Alaina K. Kipps

Keyword(s):

Cardiac Surgery ◽

Quality Improvement ◽

Chest Tube ◽

Management Strategies ◽

Practice Variation ◽

Site Quality ◽

Limited Evidence ◽

Improvement Project ◽

Tube Removal ◽

Chest Tube Removal

AbstractLimited evidence exists to guide chest tube management following cardiac surgery in children. We assessed chest tube practice variation by surveying paediatric heart centres to prepare for a multi-site quality improvement project. We summarised management strategies highlighting variability in criteria for chest tube removal between and within centres. This lack of standardisation provides an opportunity for quality improvement.

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Improving Wait Time for Patients in a Pediatric Echocardiography Laboratory - a Quality Improvement Project

Pediatric Quality and Safety ◽

10.1097/pq9.0000000000000083 ◽

2018 ◽

Vol 3 (3) ◽

pp. e083 ◽

Cited By ~ 1

Author(s):

Anitha Parthiban ◽

Ashley Warta ◽

Jennifer A. Marshall ◽

Kimberly J. Reid ◽

Keith Mann ◽

...

Keyword(s):

Quality Improvement ◽

Wait Time ◽

Quality Improvement Project ◽

Improvement Project ◽

Echocardiography Laboratory ◽

Pediatric Echocardiography

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Improving access to services through a collaborative learning system at East London NHS Foundation Trust

BMJ Open Quality ◽

10.1136/bmjoq-2018-000337 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000337 ◽

Cited By ~ 2

Author(s):

Amar Shah ◽

Auzewell Chitewe ◽

Emma Binley ◽

Forid Alom ◽

James Innes

Keyword(s):

Mental Health ◽

Quality Improvement ◽

Collaborative Learning ◽

Health Services ◽

Secondary Care ◽

Waiting Times ◽

Learning System ◽

Improvement Project ◽

Face To Face ◽

Wide Range

Early intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and non-attendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT). Fifteen community-based teams across ELFT came together with the shared goal of improving access. These teams were diverse in both nature and geography and included adult community mental health teams, child and adolescent mental health services, secondary care psychological therapy services, memory services, a musculoskeletal physiotherapy service and a sickle cell service. A collaborative learning system was developed to support the teams to come together at regular intervals, share data, test and scale-up ideas through quality improvement and have access to coaching from skilled improvement advisors in the ELFT central quality improvement team. Over the course of the 2-year project, waiting time from referral to first face-to-face appointment reduced from an average of 60.6 days to 46.7 days (a 23% reduction), non-attendance at first face-to-face appointment reduced from an average of 31.7% to an average of 20.5% (a 36% reduction), while referral volume increased from an average of 1021 per month to an average of 1280 per month (a 25% increase).

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How does clinical space utilisation impact patient flow?

BMJ Open Quality ◽

10.1136/bmjoq-2018-000542 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000542 ◽

Cited By ~ 1

Author(s):

Alexandra von Guionneau ◽

Charlotte M Burford

Keyword(s):

Quality Improvement ◽

Waiting Time ◽

Primary Outcome ◽

Patient Flow ◽

Waiting Times ◽

Wait Time ◽

Limiting Factor ◽

Electronic Systems ◽

Improvement Project ◽

Medical Wards

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

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Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative

Otolaryngology ◽

10.1177/01945998211011066 ◽

2021 ◽

pp. 019459982110110

Author(s):

Catherine F. Roy ◽

Sena Turkdogan ◽

Lily H. P. Nguyen ◽

Jeffrey Yeung

Keyword(s):

Quality Improvement ◽

Wait Time ◽

Procedural Sedation ◽

Wait Times ◽

Healthy Children ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Improvement Project ◽

A Minor ◽

Minor Procedure

Objective Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. Methods As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Results Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Discussion Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. Implications for Practice This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

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