Primary Contact Hand Therapy: addressing orthopaedic demand

Initiative Type
Model of Care
Status
Deliver
Added
15 October 2021
Last updated
26 November 2021

Summary

This optimised hand therapy service at Gold Coast University Hospital (GCUH) allows hand therapists to see an agreed cohort of less complex patients. It then in turn increases the capacity for our skilled orthopaedic surgeons to provide access to care for the more complex patients.

We are achieving this through three key models:

  1. hand therapist management of elective diagnostic conditions
  2. hand therapist management of appropriate post-operative patients
  3. hand therapist management of select diagnostic groups in fracture clinic. 

The translation of these models into practice is only made possible with strong medical governance and support from the GCUH orthopaedics team.

Key dates
Jan 2021
Jun 2021
Implementation sites
Gold Coast HHS
Partnerships
Consumer PREMS and PROMS, Orthopaedics, hand therpaists

Aim

  • improve access to care for patients awaiting orthopaedic intervention
  • optimise scope of practice for allied health practitioners to enable high value (and lower cost) care
  • deliver a service which meets and/or exceeds the expectations of consumers.
     

Benefits

Results show that this is a high value initiative that also results in a high level of patient satisfaction. 
In May 2021, 98% of patients reported they were satisfied or very satisfied with the knowledge of the hand therapist during their initial appointment. In addition, 97% of patients were either very satisfied or satisfied with seeing a hand therapist rather than seeing a doctor at their initial appointment. 
One of the benefits of this initiative is that the total number of appointments experienced per patient have been reduced. For example, instead of being seen in fracture clinic by doctor, seen by nurse for wound care, then hand therapist for therapies, this is all completed in one appointment by the hand therapist for specific patient cohorts.

Background

Orthopaedic demand continues to exceed capacity across the Gold Coast Hospital and Health Service, resulting in the hospital’s Occupational Therapy Service implementing an initiative that would optimise orthopaedic outcomes. 

 

Solutions Implemented

  • expanding the primary contact hand therapy team from 1.0FTE to 3.0FTE
  • expanding the model of care to include additional diagnostic groups in the hand therapist management of elective diagnostic conditions and trauma conditions
  • planning to implement two new approaches to supporting our orthopaedics team (post-operative substitution model and the fracture clinic substitution model).
     

Evaluation and Results

From February 2021 to May 2021 the following results have been noted:

  • 595 patients have been removed from the orthopaedic waitlist in the first four months of service
  • 68% reduction observed in our specialist outpatient orthopaedic hand and wrist long waits*
  • 98% of trauma patients are discharged back to the General Practitioner (GP) without the need for orthopaedic input
  • 32% of elective patients are discharged back to the GP without the need for orthopaedic input, and those who return to orthopaedic outpatients have fewer and shorter appointments and are more likely to convert to surgery
  • revenue offsets costs by approximately $180,000 per year.

*Note this improvement is a result of several strategies implemented by our innovative orthopaedics department at Gold Coast Health - the optimised hand therapy service is only one of these strategies.

Lessons Learnt

  • the importance of close collaboration with our medical colleagues and consumers to ensure that optimisation of scope of practice is genuinely safe, of high value and benefit, and clinician/consumer driven
  • the devil is in the detail: ensuring clinic templates, tier two clinic codes and other details are correct to accurately capture the impact the optimised service is having on orthopaedic services, and ensuring data systems are correctly capturing and reporting data
  • the value of having strong executive leadership, oversight and interest in the model, including a framework for clearly articulating the impact and benefit of an optimised scope of practice service
  • the importance of getting ‘the right mix’ to enable a high performing team: bringing tribes together (e.g. occupational therapists, physiotherapists, orthopods) 
  • ensure  the workforce profile is right for success: FTE for allied health professionals, allied health assistants and administrative support to deliver an optimised scope of practice model effectively
  • how to navigate system complexities, developed innovative strategies to overcome roadblocks and/or red tape to stay true to our vision.

References

References are available on request 

 

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Key contact

Ashlea Walker and Scott Plumbridge-Jones
Director: Occupational Therapy
Gold Coast HHS
07 56873169
Scott.Plumbridge@health.qld.gov.au

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