Implementing an advanced physiotherapy outpatient service as a quality improvement model for hip fracture patients

Implementing an advanced physiotherapy outpatient service as a quality improvement model for hip fracture patients

Αn advanced physiotherapist model in hip fracture care may reduce costs and surgical registrar time without adversely influencing patient outcomes.

Advance physiotherapy roles in elective arthroplasty across global settings have demonstrated benefit in safely reducing time burden on surgical teams and healthcare costs. The utility of similar roles in the care of hip fracture is unclear. This quality initiative, conducted in Australia, aimed to implement and evaluate a new model of care substituting a surgical registrar with an advanced physiotherapist in a post-discharge hip fracture clinic.

During the implementation of this model (October 2020- January 2023), 346 hip fracture patients (median age 75 years) were seen by an advanced physiotherapist. The following key elements were reported:

• Eighty-one patients seen by an advanced physiotherapist required brief informal discussion with the consultant surgeon during physiotherapy management sessions.
• Fifteen patients required a formal consultant review and ongoing management by the surgeon; these were routinely patients with complex pain management or requiring surgical revision. 
• There have been no patient complaints, critical incidents or other unintended consequences following implementation.
• The overall net surgical time realised over the 3 years was 110 hours. While there were no physiotherapy overtime hours, 5347 hours of registrar surgical overtime were incurred during the evaluation period.
• Cost comparative data suggest a very small cost of $A330 across the entirety of the programme, although basic modelling did not account for the reduction in surgical penalty rates for overtime. 

The study demonstrated that this model in hip fracture care is cost neutral, may reduce overtime and associated penalty payments, and free up surgical registrar time for full scope surgical tasks, without adversely influencing patient satisfaction or leading to harm.

The authors concluded that: ‘This single site quality initiative provides a passing glance at the potential benefit of an advanced physiotherapy clinic for hip fracture patients. We are looking forward to ongoing research to rigorously evaluate this innovative approach to meeting the foreseen challenge of unmet surgical demand for service in this vulnerable population’.

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