Service evaluation: Identifying the reasons for decreased patient interaction with East Coast Community Healthcare (ECCH)

using Self-Referral cards

Introduction: Demographic Value

Articles and papers on self-referral (SR) systems in general state:
• Number of participants
Direct access to healthcare encourages
autonomy from patients, allowing for AHP's to use
their time more effectively to treat people who are in
need (Riggare, 2016).
• When direct access is used, it is
not for inappropriate reasons (Ferguson, Griffin and
Mulcahy, 1999), so the service is not being misused.
• One drawback is that some patients,
especially elderly, struggle to navigate these systems. With the
lack of knowledge of the job role and promotion of patient-
directed systems, underuse of the service is seen (Igwesi-
Chidobe et al., 2020).
• NICE Guidelines state that patients should be able to actively
participate in their care NICE (2021).
Following discharge from orthopedic knee/hip surgery, patients who are
not referred by the hospital are given a SR card to contact ECCH for PT need
be. Since the introduction of the self-referral system,
The East Coast Community Healthcare (ECCH) team have highlighted the fact
that the uptake of SR is lower than expected.
This audit plans to identify the true percentage of patients failing to self-
refer to ECCH after elective joint replacement surgery and find out the
reasons why.
Methods:
A Data Protection Impact Assessment form and Good Clinical Practice/
Information Governance training was completed prior to any patient contact.
Telephone calls were made to patients between 1-4 weeks post discharge
from JPUH. Closed and open-ended questions were used allow for qualitative
and quantitative data.
A flow map and script was used during phone calls, for consistency and to
reduce researcher bias.
The results of these phone calls were collected in an excel spreadsheet along
with demographic information and analysed to find common themes. The
data was stored securely on an Excel spreadsheet.
Gender (Percentage of Male participants)
Age (mean age and sd)
Percentage of TKR patients contacted
Average interval between discharge and
final attempted phone call
Percentage of phone calls answered
By Lucas Van-Eda & Ollie Sutton (Student Physiotherapists)
Acknowledgements:
Orthopedic team
Research team
Information governance team
36
42%
71 sd=10.7
56%
17 days
92% (33/36)
Implications:
• Drawing a conclusion from this data, the procedure used to give the SR
information is mostly effective, and the reason for decreased contact with
ECCH is that patients feel they don't need it.
• As 10 participants do not recall being given the card, the inpatient services
may need to be improved to ensure that patients are able to remember
what the card is and its purpose. While also possibly changing the format
of the card to make it easier to remember, record keeping can also be
altered to ensure that all eligible patients are given a card.
• Further research can be done with a larger sample size to see if these
findings are true. While additional research can explore why patients did
not feel they need physiotherapy.
Reference list
Ferguson, A., Griffin, E. and Mulcahy, C. (1999). Patient Self-referral to Physiotherapy in
General Practice - A Model for the New NHS? Physiotherapy, 85(1),
pp.13–20. doi:https://doi.org/10.1016/s0031-9406(05)66059-2.
Igwesi-Chidobe, C.N., Bishop, A., Humphreys, K., Hughes, E., Protheroe, J., Maddison, J. and
Bartlam, B. (2020). Implementing patient direct access to musculoskeletal physiotherapy in
primary care: views of patients, general practitioners, physiotherapists and clinical
commissioners in England. Physiotherapy. doi:https://doi.org/10.1016/j.physio.2020.07.002.
NICE (2021). 1 Guidance | Patient experience in adult NHS services: improving the experience
of care for people using adult NHS services | Guidance | NICE. [online] Nice.org.uk. Available
at:
https://www.nice.org.uk/guidance/cg138/chapter/1-Guidance#enabling-patients-to-actively-
participate-in-their-care
.
Riggare, S. (2016). Self referral to physiotherapy and other services would empower patients
 Reference list
Ferguson, A., Griffin, E. and Mulcahy, C. (1999). Patient Self-referral to Physiotherapy in
General Practice - A Model for the New NHS? Physiotherapy, 85(1), pp.13–20.
doi:https://doi.org/10.1016/s0031-9406(05)66059-2.
Igwesi-Chidobe, C.N., Bishop, A., Humphreys, K., Hughes, E., Protheroe, J., Maddison,
J. and Bartlam, B. (2020). Implementing patient direct access to musculoskeletal
physiotherapy in primary care: views of patients, general practitioners, physiotherapists
and clinical commissioners in England. Physiotherapy.
doi:https://doi.org/10.1016/j.physio.2020.07.002.
NICE (2021). 1 Guidance | Patient experience in adult NHS services: improving the
experience of care for people using adult NHS services | Guidance | NICE. [online]
Nice.org.uk. Available at:
https://www.nice.org.uk/guidance/cg138/chapter/1-Guidance#enabling-patients-to-activel
y-participate-in-their-care
.
Riggare, S. (2016). Self referral to physiotherapy and other services would empower
patients and doctors. BMJ, p.h6977. doi:https://doi.org/10.1136/bmj.h6977.

•Methods:
A DPIA (GIVE FULL WORDS BEFORE USING ACRONYM) form and GCP (LIST FULL
WORDS) / information governance (IG) training was completed prior to any patient
contact.
Telephone calls were made to patients between 1-4 weeks post discharge from JPUH.
Closed and open-ended questions were used allow for qualitative and quantitative
data.
A flow map and script was used during phone calls, for consistency and to reduce
Methods: researcher bias.
Demographic data of 36 patients collected into a spreadsheet; this is stored The results of these phone calls were collected in an excel spreadsheet along with
securely to avoid risks to confidentiality. demographic information and analysed to find common themes. The data was stored
securely on an Excel spreadsheet.
A DPIA form and GCP/ information governance training was completed prior
to any patient contact.

Phone calls were provided to patients 1-4 weeks post discharge from JPUH.
Closed and open-ended questions are used allow for qualitative and
quantitative data.

A flow map and script was used during phone calls, this is used to help keep
consistency across all patients and avoid researcher bias.

The results of these phone calls was collected in an excel spreadsheet and is
analysed to find common themes.