Placement 2: Care in the Community

What is Community Physio?

My second placement is taking place in a hospital and community team (HCT), made up of physiotherapists, occupational therapists and rehab assistants. The first challenge I had to face was getting my head around what exactly our service offers, as there are other community physios, intermediate care, reablement and falls teams within the area. The way I try and describe it to patients on our first visit is that we are a ‘supported discharge’ service who see patients (age 18+) for up to 6 weeks. We get referrals from various general medical, orthopaedic and surgical wards, and can help patients with their transition from hospital back home, and enable the fulfilment of short term goals. This can be anything from helping adapt the house with equipment such as grab rails, to helping someone return to walking upstairs or to the level of activity they had before entering hospital. Obviously this depends on their reason for admission, and it is important to determine if function was declining anyway before the hospital stay. Some of the physiotherapists in the team do risk assessment and manual handling on the wards that the HCT serves, so if required, patient contact can be made before discharge.

Assessment takes place in the form of a ‘duty’ visit – where either a physio or OT visits the patient at home and gets an idea of the environment, patient needs/goals and how they have been doing since discharge. As a service, we aim to see people within two working days of discharge, but can prioritise more urgent referrals. Things that I am learning to look out for are how many steps to the front door, if there are any trip hazards e.g. edges of rugs, and all sorts of equipment I never knew existed. We also get an idea of who the support network for the patient is, and how household duties are taken care of. It really depends on the patient, and I was surprised to find on one visit that most time was spent unravelling confusion with a dementia patient, who thought she couldn’t eat because the doctor was due to visit for a blood test. We phoned her GP and determined this wasn’t the case, as well as making phone-calls to the carers to find out why no-one had been that morning. Our main priority was making sure she got fed!

Many of our patients are elderly, who may have had falls or are living with chronic health problems such as COPD, neuropathy or cognitive impairment. In the first visit we tend to determine if the patient needs can best be served by physios or OT’s. Equipment may be ordered, and referrals made to other services. The physio-specific goals such as assisting mobility, pacing or specific functional goals can be planned with the patient and reviewed in subsequent visits.

If there are longer term goals or needs, we can refer to other services such as community physios, social services, falls team, expert patient program – the list goes on. Understanding my scope of practice within this has been one of my goals, as the team is all about multidisciplinary working. Knowing what services are available is key, and it is also important that we liaise with carers and family members to help make sure everyone is on board with patient goals.

Half Way Assessment

Overall, I was generally in agreement with my educator about how I am doing so far. I have to say, it was harder to gauge my progress as there has been less patient contact (simply due to the nature of community work vs my last musculoskeletal placement). I was concerned that I have not been doing much ‘objective’ assessment, until my educator pointed out to me that simply assessing at the home environment is objective information. I know that as I move though placement I will be doing more goal setting and reviewing, which is one of the areas I did not score as well on. This may be partly due to the fact that as I have only just started building up a caseload, my patients have not progressed to the stage where I am able to review their treatment and modify as necessary. However, my half way has allowed me to set some goals that hopefully will allow me to improve as a physiotherapist:

  • Continue to take the lead in assessments, and try not to seek reassurance (this has been difficult when I’ve been out with another physio, but I am looking to go out with a different team member)
  • Initiate verbal reflection post-assessment RE goals and outcome measures. Lots of different outcome measures are available to the team, and I am trying to learn which ones are more suitable/sensitive in different situations. I also need all the practice I can get constructing SMART goals.
  • Keep a diary of new experiences/conditions and relate these to key guidelines if possible

Mainly my goals focus round assertiveness; I think I worry too much about getting things wrong, but I know it is better to try so I am going to try and push myself harder in the second half of this placement. I would love to have done a bit better in my half way, but I think it accurately reflected the stage I’m at. The main thing is my educator doesn’t have any concerns and I have goals in place to improve.

Working with Older People

As a lot of the service users are elderly, I thought I would take the time to promote the fact that it’s International Older People’s day on Wednesday 1st October! You can tweet your activity with #fulloflife, #olderpeoplesday and #physioworks.

Today I attended a CSP study day, where we were asked to consider our vision for the future of physiotherapy. With an ageing population, a lot of the comments were around our role in rehabilitation and enabling independent living. Physiotherapists are well placed to reduce future care costs by preventing falls and helping patients self manage their conditions to avoid hospital admissions. Lucy Cocker has written an excellent summary here about the CSP physiotherapy works initiative, explaining why Karen Middleton (Chief exec of the CSP) is so keen for us to promote the value of physiotherapy. With this in mind, Older people’s day is an excellent opportunity to do exactly that!

Resources available at http://www.csp.org.uk/professional-union/practice/your-business/evidence-base/physiotherapy-works

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Placement 2: Care in the Community

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