Hutt DHB physiotherapy initiative

Hutt DHB physiotherapy initiative sees shorter waiting times, better communication

A change in approach by Hutt Valley District Health Board’s physio team has seen reduced waiting times and faster treatment for fracture clinic patients.

Previously, patients would go to the fracture clinic and then be referred to the physio service. This meant they might wait up to 10 days to be seen by a physio. Hutt’s physiotherapy team suggested physios could be present at the fracture clinic each morning, so they could see patients straight away. The result has been an average of 10-15 new patients being seen a week by the physio team.

Tom Keef is the outpatient physiotherapy team leader, and a Choosing Wisely champion. He says his team suggested the change after a planning session.

“We were keen to link in more with other parts of the hospital – we can feel a bit isolated, we didn’t really know the orthopaedic surgeons even though a lot of our referrals are orthopaedics. We looked at the evidence from around the world, and it was very common to have physios in fracture clinics.”

Tom also looked into the New Zealand situation and found that about half of the DHBs had physios in their fracture clinics, particularly the bigger ones.

“Sometime the process they used was a bit ad hoc, so I wanted to make sure that in Hutt we had a process in place, that we understood what we were expecting, and that it would be reviewed.”

He says having physios based at the fracture clinic means patients start their rehab on day one, rather than having to wait for an appointment.

“Other benefits are less cost to patients, they don’t have to come back in and out, don’t have to travel and take time off work, don’t have to find babysitters and so forth – it greatly reduces the inconvenience of it.”

As well as benefits to the patient, the new approach has been positive for physios and clinicians.

“We are getting out and spending time with new people. We are starting to work with nurses and spending time with orthopaedic surgeons. It can at times be feast and famine. You can be extremely busy sometimes, but other times fracture clinic can be a bit quieter – but that can be quite nice to have some down time to do paperwork or CPD.”

He says the physios on his team quickly got to know the orthopaedic team.

“That helps with communication – it’s easier to give the doctors a call if you know them – it puts a face to the name, and for them as well. We are all on first name basis now. It also means we feel more confident about asking questions of each other if we don’t think something is a good idea.

“Everything is more team based, more multidisciplinary. Everyone is on the same page, including the patients.”

Tom hopes the new approach might be the start of physios becoming more involved in orthopaedics.

“Maybe we could help with triaging or some of the management processes. Perhaps we could use a similar system with other departments we work closely with, such as ED or rheumatology.”

April 2019