Hand Therapy Pre-operative Appointment for Plastic Hand Trauma Patients

Project completed as part of the 2023-4 Northampton General Hospital NHS Trust Green Team Competition.

Team members

Emma Baker and Lucy Wimmer, Hand Therapy Team Leads Setting / patent group: Hand therapy outpatient department

Issue:

Hand Therapy is an outpatient department accepting acute referrals from trauma and orthopaedics (T&O) consultants, Virtual fracture clinic and Plastics consultants. We work closely with both these specialties and run joint MDT clinics. All postoperative patients are required to be seen in hand therapy 3-5 post op as per British Association of Hand Therapy Guidelines. This can be challenging to find appointments at short notice and to make successful telephone contact with the patient to inform them of their appointment. If we are unable to contact a patient via telephone this results in a delay to care as extra time is required for sending out appointment letters which the trust sends 2nd class. It has been noticed anecdotally that these patients have increased complications and require higher hand therapy input as a result. There is evidence to suggest early hand therapy and good patient education can reduce complications and improve patient compliance (Johnson et al. 2020).

Intervention:

Hand therapy often need to see patients on the 3rd day post op, it was previously hard to get quick enough appointments. Patients had little to no information regarding what to expect of Hand Therapy and the timescales required. Hand Therapy admin team were often challenged by patient that their appointment was too soon as they still had postoperative Plaster of Paris or bandage in situ. The Hand Therapy Team Leads streamlined this process by creating a new pathway. This was discussed with plastics consultants and registrars for their approval. The process was disseminated to the wider Hand Therapy Team and communicated to the Therapies manager. In the new pathway, patients identified as needing surgery are sent straight from their plastics appointment to the hand therapy department. A hand therapist sees patient when able (usually within 15 mins) to discuss the hand therapy process with patient and answer questions. provide handout including general post op information and Hand Therapy contact details. Complete Quick DASH outcome measure complications also discussed Schedule hand therapy appointment for 3-5 days post op where possible The plastics team complete a hand therapy referral and no further action is needed until the patients first appointment 3 days post op.

Outcomes:

We have compared outcomes for 10 patients on each pathway, with the below savings projected annually. Patients The number of patient appointments reduced as well as duration under hand therapy (by 21.2%) and consultant care. There was a reduction in delayed care and patient satisfaction was maintained/ slightly elevated generally throughout the service. We received good feedback verbally from the consultants and improved communication and confidence between departments. Patient expressed verbally that they felt a sense of confidence that they knew the plan going forward, and physically where to come to for their appointment which helped to reduce stress and anxiety.

Environmental savings

For 10 patient episodes of care we observed a reduction in 33 appointments with the consultant team (726 kgCO2e) and a reduction in 45 appointments with the hand therapy team (990 kgCO2e). This is an average saving of 171.6 kgCO2e per patient.

With an average of 11 post op plastics patients referred into the service per month, we anticipate annual savings of 22,651.2 kgCO2e, equivalent to driving 66,896 miles in an average car

Financial savings

A reduction in 33 consultant appointments saves £6,072 from 10 patient episodes of care. Projected across the year to full caseload, this is £80,150. A reduction in 45 hand therapy appointments equates to £618.75 from 10 patient episodes of care. Projected across the year to full caseload, this is a saving of £8,168. DNA cost savings: We have conservatively estimated we can prevent 1 DNA per month, a saving of £165 a year.A 43% decrease in stock cost for the HT team was seen equating to £26.45 (£2.65 per patient). projected across a year this equates to £349.

In total the projected annual savings from the project are £88,829.

Social impacts

330 hours of hand therapy and 110 hours of 'other' appointments are projected to be saved within a year that can be redirected to higher value work.

Patient comments:

"Everyone should be aware of environmental impact. Any effort to be sustainable is a good effort”

“We all have to do our best to minimise carbon footprint, hope the therapy unit can do this too”

Staff comments:

I found it really improves patient pathway and improves admin systems and it reduces patient anxiety (Hand Therapy)”

“I think it is so much quicker and it has saved me a lot of work and I appreciate the change in the system (Admin)”

“Thank you, this is excellent work. My appraiser was very impressed with the results of the audit, he has recommended that you register this audit with the trust quality and effectiveness group (Consultant)”

Key learning point

We found that good communication between staff members and teams was key to the success of the project. Positive feedback from staff and patients was a motivating factor to continue and succeed with this project. Overall attitudes to the project have been positive because the multiple benefits have been apparent.