Dear Sue,
our department now uses a screening approach. This came about because of
our experience working in G.P. clinics where experienced senior
physiotherapists had 30 minutes to assess and commence management of the
patient. To our astonishment less reviews of the patients were required.
On screening the patient is isolated from the main department with its
machines, usually in a separate room. They are advised that they are being
screened in an attempt to commence management of the problem earlier and
that specific treatment may not start immediately. In conjunction we use a
questionnaire on LBP to help classify and identify presence of yellow
flags(Waddells) and red flags, disability(RMDQ) and pain levels(VAS) for
appropriate patients. From here the patient is commenced on suitable
management with priority treatment, or placed on the waiting list, or given
an appointment for an educational class( Back school, Neck School, OA Knee
school, School for bravery) or given a review appointment, or discharged.
Patients placed on the waiting list realistically are seen 2 to 4 weeks
after and are seen by a less experienced physiotherapist but a plan and
options are provided by the initial screening assessment. They are provided
with 30 minutes to review that patient and commence specific treatment or
reassess if there was no significant improvement after the initial
screening. Patients reviewed after a month by the original screening
physiotherapist are given 15 minutes.
This process has been audited and produced significant decrease in
waiting lists, earlier referral to educational programs and thus reduced
number of 'hands on' treatment. (I can send specific data if required).
To enable this process, the waiting list has to be reduced initially by some
form of initiative, e.g. more WTE's therapists and the educational programs
have to be geared to cope with greater numbers.
One problem we had was using experienced therapists from other
outpatient specialities e.g. hand, A&E, because when they cancelled clinics
they could not make up for these as they had to still attend the specialist
clinics. This fact has encouraged the creation of a new senior post to
manage the screening process and provide the cover for other experienced
therapist screening clinics.
Kevin.
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