let's talk research annual conference - 24th-25th september 2014 (martin troedel)
TRANSCRIPT
Pedagogy
to up skill Advanced
Practice Physiotherapists
to enhance patient journey
and experience in the
Emergency Department
Negotiated Work Based Learning:
Martin Troedel Advanced Practice Physiotherapist,
Emergency Floor Therapy Team (EFTT)
The Royal Liverpool University Hospital, UK
Background: Role development for
AP Physiotherapists in the ED
1 Department of Health. Equity and Excellence: Liberating the NHS , London; 2010
2 Department of Health. European Working Time Directive: for Trainee Doctors – Implementation
Update; 2009
National drivers: NHS Reforms in UK1
+ Impact of EWTD2
Local drivers: Opportunity for role development
Consultants recognised PT skills and potential
NWBL: skill development
Jibuike (et al, 2003)
•Unlikely to miss significant injury &
crossed organisational boundaries
Ball (2007)
•Good image interpretation skills and
high patient satisfaction
Taylor (et al, 2011)
•Primary contact physiotherapy can
meet targets and reduce length of stay
in ED
Why PTs suitable for this role?
Clinical context
NWBL creates bespoke University level education in the work
place through a partnership agreement: not traditional
‘TAUGHT’ module
Collaborative approach Let’s train our
Physiotherapists to be Primary Contact Physiotherapists
Negotiated Work Based Learning (NWBL)
•Bespoke modules to develop new
skills – Plain Film Radiograph
(PFR) interpretation and Primary
Contact Physiotherapy
management of low energy foot
and ankle trauma (LEFAT)
•NWBL merges educational theory
with work-based practice and
successfully translates theory into
practice
2x20 credit modules at Masters level
University of Liverpool
GOVERNANCE1
1 Francis, R. The Mid Staffordshire NHS Foundation Trust Public Inquiry report. London, 2013
NWBL: Bespoke Module Specification
Aims
Learning Outcomes
Syllabus
Resources
Learning, Teaching and Assessment
Patient safety1
1 Francis, R. The Mid Staffordshire NHS Foundation Trust
Public Inquiry report. London, 2013
Assessment strategy
Comparable with medics
OSCE – PFR (40 cases LEFAT)
RDOPS – PFR(100 cases LEFAT) 4
4. Royal College of Radiologists, Rad DOPS Assessments, 2011, London, UK
5. Royal College of Radiologists, Mini IPX , 2013, London, UK
Mini IPX5
Competence to practice
OSCE – 88%
RDOPS – 100% 1
1. Royal College of Radiologists, Rad DOPS Assessments, 2011, London, UK2
2. Francis, R. The Mid Staffordshire NHS Foundation Trust Public Inquiry report. London, 2013
On-going evaluation
Research question
1 Boud DS. Work –based Learning: A new higher education? Open University Press,
Buckingham; 2001
Has the NWBL¹ pedagogic model
been successful in up skilling an
Advanced Practice Physiotherapist to
be competent and safe in a defined
extended scope of clinical practice
managing LEFAT?
Primary research aim
Evaluate critically the effectiveness
of NWBL as pedagogy in up skilling
an AP Physiotherapist to
competently perform a defined
extended scope of practice
managing LEFAT to enhance service
delivery in the ED of an acute tertiary
referral NHS Hospital Trust.
Method
A mixed methods research approach:
• prospective pilot clinical audit
• prospective structured patient experience
questionnaire (PEQ)
• retrospective data comparison
Alignment with ED clinical quality indicators¹
¹Department of Health. Urgent & Emergency Care, 2010.
Method
Local ethical approval was granted
Data collected prospectively by a single AP
Physiotherapist
Patient inclusion criteria were patients presenting to ED
Minors with a low energy foot or ankle injury.
Exclusion criteria were open fractures or wounds, burns
and foreign bodies.
Retrospective data was collected via iPM system¹
4 week audit period from March 12 to April 8th, 2012. ¹iPM/Lorenzo, CSC (UK), 2012.
Patient experience questionnaire (PEQ)
NRES, 2011
Patient experience questionnaire (PEQ)
Age
range
Mean
age
16 - 67 51
Prospective pilot clinical audit results (n=14)
Demographics
Age
range
Mean
age
16 - 67 48
Prospective PEQ results (n=12)
Demographics
Retrospective data comparison (n=217)
Demographics
Age
range
Age
mean
12-89 35
Gender
(n=217) count %
male 110 50.7
female 107 49.3
total 217 100.00%
Q5 Were you given enough
privacy when you were being
examined/treated by the
Physiotherapist? (n = 12)
Count %
Yes, definitely 12 100.00%
Yes, to some extent 0 0%
No 0 0%
Total 12 100%
Prospective PEQ results (n=12)
Q8 Did you have confidence and trust
in the Physiotherapist? (n = 12) Count %
Yes, definitely 12 100.00%
Yes, to some extent 0 0%
No 0 0%
Total 12 100%
Prospective PEQ results (n=12)
Q9 Did the Physiotherapist
listen to what you had to
say? (n = 12)
Count %
Yes, definitely 12 100.00%
Yes, to some extent 0 0%
No 0 0%
Total 12 100%
Prospective PEQ results (n=12)
Q12 Were you given enough information about
your condition/treatment by the
Physiotherapist? (n = 12)
Count %
Yes, definitely
12 100.00%
Yes, to some extent 0 0%
No 0 0%
Total 12 100%
Prospective PEQ results (n=12)
Q15 Did you feel that your needs were met
by the Physiotherapist? (n = 12) Count %
Yes, definitely
12 100.00%
Yes, to some extent 0 0%
No 0 0%
don't know 0 0%
Total 12 100%
Prospective PEQ results (n=12)
Prospective PEQ results (n=12)
Retrospective data comparison (n=217)
Total time spent in ED (minutes)
13%
27%
21%
17%
9%
5%
8%
30 - 60 61 - 90 91 - 120 121 - 150 151 - 180 181 - 210 211 - 240
Pie chart depicting percentages of total time spent in ED
(minutes)
Range
(minutes)
Mean
(minutes)
32 - 240 114
Results summary
Prospective data indicated the average
total time patients assessed by the AP
Physiotherapist spent in the ED was 109
minutes.
This data indicates all patients assessed
by the AP Physiotherapist were assessed
and discharged well before the four hour
target for ED (DOH, 2012).
Results summary
PEQ data reveals a very high level of patient
experience satisfaction with the AP
Physiotherapist.
All respondents reported 100% satisfaction
with the level of privacy and dignity
maintained by the AP Physiotherapist; during
consultation, examination and treatment, and
that all their needs were met.
Study limitations
Evaluation of the work of a single AP physiotherapist
– are results attributable to an individual or
applicable for all AP physiotherapists?
Scope of the study was limited by time and funding
resources, limiting the prospective numbers
recruited and the duration of the audit period.
Scope of the study limited the ability to compare the
AP physiotherapist with other clinicians such as
ENPs and doctors in the Minor Injury Unit of the ED.
Future research
The evidence base for AP physiotherapy
services in the ED indicates a developing high
quality service which can decrease length of
stay, improve diagnostic accuracy and provide
consistently high levels of patient satisfaction.
Several studies acknowledge the need for future
investigation of longer term health outcomes
using randomised controlled trials, service
models and cost effectiveness evaluation¹
¹Ball, 2007, Bethel, 2005, Hawes, 1996, Jibuike, 2003, Taylor, 2011.
Conclusion
• NWBL enabled the AP Physiotherapist to work as a
primary contact physiotherapist in the ED.
• CPD and evaluation of clinical skills essential for
patient safety and clinical governance1
• NWBL is beneficial for the development of AP roles
for physiotherapists and is important for their on-
going professional development using a unique
pedagogy, as they evolve into roles previously
undertaken by doctors.
1 Francis, R. The Mid Staffordshire NHS Foundation Trust Public Inquiry report. London, 2013
Conclusion
Strengths of the study are the very high level of
patient experience with the AP Physiotherapist, and
the high quality of service delivery in the ED.
Evaluated critically against national indicators of
quality of care delivery in the ED, the AP
Physiotherapist provided the balanced and
comprehensive care ED’s strive to achieve²
Future investment will help to support a culture of
research to evaluate these pioneering services.
2 Department of Health. Urgent & Emergency Care, 2010.
AP Physiotherapists in the ED
‘...enhance the
ability of
departments to
meet government
targets by
reducing waiting
times...deliver
quality
outcomes... and
they are popular
with patients...’¹
¹Bethel , 2005 Taylor , 2011
Co-authors:
Julie Bridson-Walton, Head of Postgraduate Studies, Institute of
Learning and Teaching, Faculty of Health and Life Sciences,
University of Liverpool, UK
Fiona Cowell, ESPP, Trauma Clinics
Dr Lawrence Jaffey, Consultant Emergency Physician
Mr Badri Narayan; Consultant Orthopaedic Surgeon
The Royal Liverpool and Broadgreen University Hospitals NHS
Trust, Liverpool, UK
Contact: [email protected]
Questions/discussion?