Turning spinning into winning at Logan Vestibular Service

Aim

1. Reduce Ear Nose and Throat and Neurology wait times for patients with vertigo and/or vestibular disorders
2. Facilitate timely discharge for inpatients with vertigo
3. Create a more sustainable workforce by offering specialised pre-registration student placements.

Outcomes

Patients have benefited greatly from expansion of this specialised service. This has been exemplified by positive unprompted consumer feedback. See attached document, "The Pulse" (final page, bottom left): "I have had several appointments with the ENT Physio for troublesome vertigo and she has done wonders! Her methods are gentle, but very effective. Her manner cannot be faulted - she has improved my life!! I am very grateful for this free service. Top marks to the Logan Outpatients ENT Clinic. The girls in reception are excellent too! Thank you, Betty"

Another benefit is the income generation of these vestibular clinics. In 2017-2018, the clinics generated 35.66 Queensland Weighted Activity Unit (QWAU) with only 1.2 FTE of HP staff. The team reached their target and secured recurrent funding for the vestibular staff.

Expansion of first point of contact vestibular physio and diagnostic audiology. Within 3 years the FTE has expanded and has won a Board Chair award. Clinical redesign, new secondary pathway, consultancy service for inpatients, pioneer permanent vestibular physios, first hospital in Qld to create a specialised pre-preregistration vestibular physio student placement.

Background

In 2016, funding was granted to expand the vestibular service to include onsite First Point of Contact (FPOC) Vestibular Physiotherapy and Vestibular Diagnostic Audiology. Within three short years, the staffing full time positions have multiplied significantly and the team won the 2018 Metro South Board Chair's Award for 'Delivering Our Values: Unleash Potential'.

Discussion

The Logan Hospital Vestibular Service now has five distinct streams:

1. FPOC (primary contact) ENT AH Vestibular Clinic [Physiotherapy-Led Clinic]
2. FPOC Neurology AH Vestibular Clinic [Physiotherapy-Led Clinic]
3. Secondary Contact Vestibular Diagnostic Audiology Clinic
4. Secondary Contact Vestibular Physiotherapy Clinic
5. Vestibular In-reach Physiotherapy Service (inpatient vestibular consultancy service)

The FPOC AH Vestibular Clinics (Stream 1 and 2 above) serve to discharge patients off specialist ENT and Neurology waitlists, without the need for specialist medical/surgical review. Between 2013 (early single discipline clinic) to June 2019 (multidiscipline clinic), 630 patients have been discharged off the Neurology and ENT Specialist Outpatient Waitlists, with 90% of those patients discharged without any need for a medical appointment. The patient wait times have drastically reduced. For example, prior the FPOC AH Vestibular Neurology clinic, the mean wait time for a neurology referral for dizziness was 589 days. After commencement of this advanced scope AH clinic, the mean wait time for this referral type dropped to just 49 days. This is an improvement of 540 days in one year!

Vestibular physiotherapy staffing FTE has tripled in size since 2016. Starting out at only 0.26FTE for a single position in the ENT FPOC, there are now three permanent vestibular physiotherapy positions. This has created a very clear succession pathway (1 x HP3, 1 x HP4 and 1 x HP5 position) and reduced the risk of service failure due to inadequately trained staff. We are the first hospital in Queensland to offer a permanent vestibular physiotherapy position across three different HP levels. To summarise the growth, in three short years, the FTE amount has increased approximately 5-fold to a total of 1.3FTE. Even though this FTE is still a small amount, in 2018-2019 there were 863 outpatient occasions of service by the vestibular physiotherapy team.

In June 2019, the vestibular physiotherapy service included the Vestibular In-reach Physiotherapy Service. Staffed at only two hours a day, the on-call physiotherapist will attend a patient staying on a ward and provide specialised high-tech vestibular assessments. Since inception, 131 inpatients have had access to this high-quality, high value care.

Lessons learnt

1. Executive and operational support to trial alternative/innovative service delivery models is essential
2. Trust between AH & Medical staff, dedicated geographical space and co-location of clinical service staff were key success factors in guiding behaviour and enhancing communication
3. Small FTE amounts provide a platform to showcase what a small team can achieve, this can then be built upon as KPIs are met
4. Creating a dedicated Vestibular Physiotherapy Stream has enhanced patient access to this specialty service and encourages streamlining of vestibular services across the hospital
5. Graduate entry physiotherapy students are eager to learn this specialty area and have come well prepared. Investing in student supervision leads to sustainability and future proofs specialty pathways