Ruth Cox1, Sue Laracy2, Celeste Glasgow2, Kathy Green3, Leo Ross1
1QEII Jubilee Hospital, Coopers Plains , Australia, 2Royal Brisbane and Women’s Hospital, Herston, Australia, 3Logan Hospital, Meadowbrook, Australia
Study Design. Prospective cohort study
Introduction. Public hospitals face an escalating challenge of providing specialist outpatient services and elective surgery within clinically recommended waiting times. There is emerging evidence that advanced scope of practice occupational therapy-led hand clinics improve outcomes.
Purpose of the Study. The effectiveness of advanced practice hand therapy for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals was evaluated.
Methods. Patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patient perception of change as measured by Global Rating of Change (GROC). The relationship between waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and ANOVAs were used for statistical analyses.
Results. Fifty-nine percent (59%) of the 1,947 patients were removed or discharged from the surgical outpatient waiting lists. Of the sub-set of patients who completed hand therapy (n=1,116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe and patient satisfaction was above 90%. The mean GROC score was +2.09 (± 3.58) but varied across diagnoses with trigger finger/thumb showing the greatest improvement (+4.21 ± 2.92, p<0.01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (p<.001).
Conclusions. Primary Contact Occupational Therapy Hand Clinics are an innovative model of care which have contributed to improved patient outcomes and significant reductions in surgical outpatient waiting lists across Queensland. The model of care and the strategies used in evaluation, including lessons learned, will be of interest to all allied health professionals.
Ruth Cox is the Director of Occupational Therapy at the QEII Hospital in Brisbane. She is passionate about consumer partnerships, translation of research evidence into clinical practice, and development of innovative models of care. Her research interests also include service outcomes and evaluation, and staffing skill mix and its effects on patient and organisational outcomes. She has a Masters of Business Administration in addition to her Occupational Therapy Honours Degree.