Allied Health Led Post-Operative Hand Clinic

Aim

The aim of this study was to evaluate the effectiveness, safety and patient satisfaction of this alternative service delivery model.

Outcomes

• prevent double handling of outpatient specialists and  therapist appointments
• save on consumable waste
• save waiting times for patients
• enable specialists to see more complex patients quicker.

Background

An increasing and unsustainable orthopaedic workload in our hospital has led to the need to develop a solution that would also address patient flow.

Discussion

Prospective mixed method design evaluation was undertaken by occupational therapists and physiotherapists working in the field of hand therapy. Satisfaction surveys were completed by orthopaedic doctors and patients. Patient outcomes were assessed using the Quick Disability of Arm, Shoulder and Hand questionnaire, total active range of motion, Crawford classification, sensation and pain at six weeks post operatively.

Data was collated and analysis of free text content for commonly occurring themes were grouped for interpretation. All complications and readmissions within a three-month period were identified and recorded to determine effectiveness and safety of the service.

For the six-week post-operative review, 81 patients were seen by an allied health professional rather than a doctor.  Patient satisfaction was high with 90 per cent of patients satisfied with post-operative care provided by allied health; 2 per cent of patients preferred to be seen by a doctor. Doctor satisfaction was also high with 95 per cent of doctors being satisfied and confident with the quality of care provided.

A high proportion of patients reported pain 2/10 or less with activity (82.72per cent), had full sensation (69.14 per cent), excellent range of motion (82.72 per cent), and Quick Disability Arm, Shoulder and Hand scores on average were below 25 per cent indicating minimal functional deficits. Only five patients required doctor involvement post-operatively.

Lessons learnt

Liaise with a data statistician as early as possible in the process.

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