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.

Physiotherapy-Led Musculoskeletal Telephone Triage and Advice Service: A Valid Option for Patients Referred From the Emergency Department

“…At the Queens Hospital Burton site of the University Hospitals of Derby and Burton National Health Service (NHS), the MSK physiotherapy department observed a high rate of failed attendances from patients referred from the emergency department, recording 14.4% of initial appointments not being attended by patients. These findings were not uncommon and were similar to the aforementioned studies [6,10,11].…”

“…A senior physiotherapist was utilized to provide self-management and advice for each of the conditions. Although the study used a small sample size, the researchers concluded the service reduced waiting times and was accepted by service users [11].…”

“…These services are aimed to decrease waiting times and reduce non-attendances [10]. Existing literature investigating the effectiveness of telephone consultations in physiotherapy has been limited [11]. The majority of the literature has analyzed telephone consultations delivered by nursing staff in an Asthma clinic [12].…”

“…Although there is limited literature in physiotherapy outpatient settings, it has been demonstrated, TTAD assessments can reduce waiting times, whilst being clinically effective in comparison to face-to-face assessments in a physiotherapy department setting [6,11]. From further analysis of the literature, it was apparent that only one study demonstrated the implementation of an option for telephone assessment service in MSK outpatient physiotherapy for patients referred from the emergency department [11]. This study analyzed face-to-face routine appointments in comparison to telephone consultations.…”