Ab1626-HPR Improving Access to Specialist Rheumatology Physiotherapy: A Quality Improvement Project

Background: Guidelines recommend early specialist physiotherapy input for patients with inflammatory arthritis. After the COVID-19 pandemic, services were disrupted and waiting times for rheumatology physiotherapy services in our department increased to >26 weeks. UK guidelines 1 advise that care for patients with non-inflammatory musculoskeletal conditions should be provided in primary and community care settings. Objectives: To evaluate access to the hospital rheumatology physiotherapy service, define a referral pathway and improve access for patients. Methods: A service evaluation measured patient flow, rheumatology physiotherapy clinic utilisation and waiting times. A quality improvement project using a PDSA process was conducted. Data were re-analysed 12 months after implementation of changes. Results: In the service evaluation, access to specialist rheumatology physiotherapy was found to be inconsistent due to lack of a defined pathway or specific referral system. Patients triaged onto routine hospital therapy waiting lists waited 26.5 weeks, exceeding the waiting times in primary care. 40% of referrals for specialist rheumatology physiotherapy from Oct-Dec 2022 were for non-inflammatory conditions. Specialist rheumatology physiotherapy clinics were under-utilised. In December 2022, a specialist rheumatology physiotherapy referral system with specific inclusion and exclusion criteria was implemented. Rheumatology doctors and nurses were educated about how to redirect patients with non-inflammatory conditions to therapy services in primary care. A resource sheet was designed to signpost these patients to self-management resources. Referral data were recorded in a run chart (Figure 1). Analysis at 12 months after the intervention demonstrated a shift in the referral process with a reduction in number of referrals for specialist physiotherapy after June 2023. Waiting times for patients with inflammatory disease fell by 17.5 weeks. Capacity in the specialist physiotherapy outpatient clinic improved, with a 30% reduction in follow-ups, allowing patients earlier access. The non-attendance rate of this clinic was reduced by 11%. Conclusion: Careful evaluation of patient pathways can lead to sustained improvements in access to care. We have improved access to therapy in our department for patients with inflammatory disease. Access to care through the therapy services is now compliant with UK guidelines to ensure that the right patients are being seen in the right place at the right time. This has allowed the rheumatology therapy service to increase its capacity ensuring that patients with inflammatory disease have timely and equitable access to specialist therapy. Future work is required to develop services within primary care for patients with persistent pain in the absence of an inflammatory arthritis. REFERENCES: 1 Kay et al (2021). 'Rheumatology GIRFT Programme National Specialty Report'. Acknowledgements: NIL. Disclosure of Interests: None declared.