Carol David wrote:
> Catherine Neyland wrote:
>
> > ......... Main Conclusion
> >
> > Medical staff required more information/clarification of the role of the
> > emergency on-call physiotherapist:-
> >
> > * hours of on-call duty - physiotherapist not based in the hospital
> > (84% of inappropriate call-outs were made at a weekend)
> > * call-out procedure
> > * type of patient who the service is for/not for
> > * conditions likely to respond to physiotherapy intervention
> > * conditions which physiotherapy can have no effect
> > * agreed written emergency duty protocol - copy for medical staff
> >
>
> Dear Cathy, thanks very much for the info. I agree re: educational need -
> I've often wondered how doctors learn the indications for chest physio. I'd
> go further and say that physios need to learn as well - we weren't good at
> predicting which patients would benefit from physio either.
We found that during the course of the Audit, that Physiotherapists became much
more aware of what constituted an inappropriate call-out, and were more likely
to question the appropriateness of call-outs by the medical staff, and also
those patient's that were put on the weekend lists by the Physiotherapist's
themselves.
> We found the proportion of inappropriate calls at the weekend to be 100%.
> Perhaps as you say there is some uncertainty as to our normal working hours.
> Also, the majority of our inappropriate weekend calls were generated by the
> same consultant - as his op day is Friday he argued (justifiably) that
> everyone else's patients got seen first day post-op, why should his be
> disadvantaged.
We had several inappropriate call-outs from the orthopaedic medical staff for
patient's that had been operated on at the end of the week, and were due to be
mobilised/up to sit for the first time at the weekend. Our emergency duty
protocol states that the on-call service is for 'acute respiratory conditions,
likely to respond to physiotherapy' - not for mobilising patient's. Again, this
could be resolved with better education/communication with the medical staff (or
weekend orthopaedic cover!).
> We have sorted this out now by using identical criteria for working hours
> and out of hours treatment. We identify pre-op risk factors (current smoker
> and/or COPD, or 2 out of the following: age>65, asthma, obesity,
> malnutrition, physical disability) and see those patients routinely post-op.
> In addition we are piloting objective criteria for the unexpected - at least
> 3 of the following need to be present:
> 1. Abnormal breath sounds
> 2. Pyrexia>38degsC
> 3. SO2 <94% on air
> 4. O2>40% / 6litres
> 5. Abnormal CXR
> 6. Patient not managing symptoms
>
> (NB Although the above are literature-based, I would still welcome any
> comments on the criteria. With refs if possible - without them we lose a lot
> of credibility with the medics when we're trying to change their practice.)
> So the criteria for post-op emergency work assumes healthy lungs pre-op (if
> not, the patient will already have been identified as at risk pre-op) and
> are therefore sign/symptom led, reasonably clear and straightforward.
> However, most medical chest patients are admitted with acute on chronic
> exacerbations, and we feel that criteria for call-out may need to be more
> condition-led, with a flow diagram for action rather than a check list of
> signs. (e.g. Asthma: assess for the following objective signs, give neb,
> re-assess, if X is present then call physio, if Y is present then physio is
> not indicated).
>
> I am particularly interested in your 3rd, 4th and 5th points: i.e. who
> emergency service is/not for, conditions amenable and not amenable to
> physio, and if you (or anyone else on the list) have any evidence for these,
> I'd be most grateful.
>
> Regards,
>
> Carol David
Unfortunately, as I am in Dubai now - and did not bring out any of my
respiratory books/information or my audit file, I cannot give you the
references - although I suspect that Alex Hough will have them in her book. I
got alot of my information from an Audit workbook produced by Dundee University
for health professionals - someone had produced criteria similar to yours above,
and included it in a proforma for staff to use - perhaps someone on the list has
a copy of the workbook??? Sorry cannot remember the title: '............to
Audit'.
Sorry I am unable to be of any more help. Had I been able to continue with the
audit, I would have gone along similar lines to you with regard to a flow chart
- in consultation with the medical staff.
Cathy
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