Video Enabled Care Webinars Trauma Hand Therapy Service 11/11/20 - - PowerPoint PPT Presentation

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video enabled care webinars trauma hand therapy service
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Video Enabled Care Webinars Trauma Hand Therapy Service 11/11/20 - - PowerPoint PPT Presentation

Jul 18, 2023 157 likes •360 views

Video Enabled Care Webinars Trauma Hand Therapy Service 11/11/20 Edel Siney, Clinical Specialist OT Brian OCeallaigh , Senior Physiotherapist Aisling Coen, Staff Grade OT Andy Byrne, Staff Grade Physiotherapist Agenda Overview of

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Video Enabled Care Webinars Trauma Hand Therapy Service

11/11/20 Edel Siney, Clinical Specialist OT Brian O’Ceallaigh, Senior Physiotherapist Aisling Coen, Staff Grade OT Andy Byrne, Staff Grade Physiotherapist

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Agenda

  • Overview of Service: Plastics Service UHG, Activity Levels
  • Covid-19 Pandemic
  • Outcomes; Pros, Cons, Patient Feedback
  • Enablers & Barriers
  • Case Studies;
  • minor injuries
  • post op complication
  • tendon repair
  • outlier referral
  • Resources
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Plastics Service UHG

  • Regional service
  • Population 730,513 – 15.3% Irish population
  • 6 Consultants
  • Staffing resources
  • 1 wte Clinical Specialist OT
  • 1 wte Senior Physio
  • 1 wte Staff Grade Physio
  • 4 consultant led post op clinics per week
  • Inpatient and outpatient service
  • Trauma and elective surgery
  • Direct access hand therapy for ED Minor Injuries
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Activity Levels – Hand Therapy Referrals

Referrals 2019 (1,620)

Plastics trauma (1,264) Minor injuries ED (244) Other (112)

500 1,000 1,500 2,000

2003 2013 2019

Plastics Hand Therapy Service growth 2003-2019

New Referrals

Referrals 2018 (1,571)

Plastics trauma (1,257) Minor injuries ED (225) Other (89)

Referrals Jan – Oct 2020 (1,424)

Plastics trauma (1,190) Minor injuries ED (200) Other (34)

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Covid-19 National Guidance

  • Closure of outpatient services

UHG Telehealth Steering Committee

  • Attend Anywhere Pilot Project

Current Hand Therapy Service

  • 70/30; Telehealth vs face/face

Covid-19 Pandemic

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Outcomes

Pros

  • Patient and staff safety
  • Identify need for face/face review
  • Variety of patients and services
  • Access to patients
  • MDT sessions
  • Monitor progress/complications
  • Visual feedback/compliance/understanding
  • Screen Share
  • Patient reassurance
  • Client centred
  • Economical benefit patient/health service
  • Clinical reasoning development

Cons

  • IT issues
  • Wifi connection
  • Computer vs phone
  • Pixel quality
  • Attend Anywhere log in trouble
  • Takes time to become confident
  • Extra admin time
  • Not suitable for all patients
  • Doesn’t replace face/face
  • Objective outcome measures
  • Patient Attendance
  • Therapist fatigue
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Barriers and Enablers

Practical Elements

  • Identifying suitable patients
  • Explaining telehealth
  • Attend Anywhere, WhatsApp, Email, Telephone
  • Access to online medical records
  • Scheduling appointments
  • Clinical space for telehealth
  • Documentation
  • Telehealth protocols
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Case: Minor Injuries

ED Ax

  • Female, 28, referred to ED following injury to right middle finger following impact

from ball while playing softball

  • X-ray: non-displaced avulsion fracture on volar aspect at base of middle phalanx
  • Referred directly to OT from ED

OT initial Ax

  • History and relevant background gathered
  • Assessment of ROM, tendon recruitment and ligament stability.
  • Findings: volar plate avulsion injury PIPJ
  • Treatment: education, dorsal block splint, coban wrap and exercises provided

Follow up

  • Information given on Attend Anywhere, email address taken and follow up

appointment arranged for 3 weeks’ time

  • Email sent reiterating splint regime and exercise program for the next 3 weeks and

confirmation of follow-up appointment with link for Attend Anywhere attached

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Review 3/52

  • DNA-> phone call to patient
  • Subjectively: ongoing report of pain, tenderness, swelling, ROM improving
  • Compliance with splinting and exercise programs
  • Plan: remain in splint and continue exercises until follow up in 1 week.

Review 4/52

  • Subjective: mild discomfort, other symptoms settling
  • Objective: full active extension of PIPJ, decreased active flexion
  • Plan: removal of splint in ADLs as tolerated, wear for work when needed, tendon

gliding exercises

Final Review 6/52

  • Subjective: pain free, happy with progress, weaned out of splint for all ADLs
  • Objective: mild PIPJ oedema, full extension, almost full fist - passively correctable,
  • Plan: discontinue splint, tendon gliding exercises, theraputty strengthening, contact

OT department if any issues

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Reflection

Pros

  • Convenience for patients- working from home etc.
  • Cohort of patients usually receptive to telehealth
  • Less face to face contact/less footfall through the hospital
  • Subjective outcomes-patient concerns at the forefront

Cons

  • Need to send reminders for patient appointments
  • Technical issues for some patients- internet connection, equipment,

unfamiliarity etc.

  • More organisation required from OT
  • No standardised objective measure for outcomes
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Case – Post op complications

Background

  • 63 year old male
  • 3/12 hx recurrent IF

infections following a laceration.

  • Underwent washout

under LA.

  • Referred to Physio

while an IP.

  • Followed up in clinic

a few days later.

  • R/v’d by Plastics and

arranged clinic f/up in 1/12

Follow up

  • Patient was

managed virtually.

  • Weekly video calls

to Ax ROM and wound healing.

  • Week 2 concerns

raised regarding signs of infection.

  • Arranged

immediate Attend Anywhere appointment.

Telehealth

  • Barriers:
  • Poor pixel quality.
  • Decrease accuracy

with AROM Ax.

  • Enablers:
  • Local steering

committee supports the use of WhatsApp.

  • Installed on our HSE

work phone.

  • Clearer quality.
  • Easily accessible and

patient friendly.

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Outcome: Liaised with Plastics team Dr’s. Pt was brought into hospital the following morning for washout Safety Netting If in doubt, arrange Face to Face appointment

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Case – Tendon repair

Patient

  • 63yr Male
  • MOI: Angle grinder
  • Zone V EDC /EIP LIF
  • RHD, retired,

independent baseline, active, enjoys fishing and gardening

  • Lives alone, isolated

island

  • Non smoker,

Pancreatic CA, T1DM

Referral

  • OPD Day 5 post op
  • R/v by Plastics Team
  • Op notes: strong

repair, no other structures involved

  • Wound review – no

signs of infection, dressings changed and PHN f/u

  • Hand Therapy – RM

protocol, splint fabricated, allowed use hand functionally within splint

Follow up

Factors considered;

  • Lives on island
  • Transport issues
  • No family

nearby/isolating

  • Level 5 restrictions on
  • utpatients
  • Straightforward post
  • p protocol
  • Patient high risk

category

  • Patient recently

started using zoom with family

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Outcome

Telehealth sessions

  • 2/52, 4/52, 6/52, 10/52

post op - Zoom

  • Followed RM protocol
  • Assess tendon

recruitment

  • Monitor wound healing

and scar management

  • Monitor for

complications

  • Rehab programme

Outcomes

  • 1 face/face session, 4

telehealth sessions and d/c

  • No complications
  • Full ROM return and

return to baseline function

  • Picture documentation:

ROM, tendon recruitment, scar

  • No objective measures:

grip strength, TAM

Supports

  • PHN wound review
  • Patient had basic

computer literacy

  • Very compliant patient
  • Zoom – good pixel

quality, good connection

  • Good communication

with surgical team

  • Plastics team

supportive of hand therapy & telehealth

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Case – Outlier referral

Patient

  • 48yr Female
  • Hx. bilateral CTS

approx 3yrs. L>R

  • RHD, Biomedical

Engineer

  • 3 children, caring

for elderly mother

Referral

  • L CT decompression
  • Referred at 5/52 post
  • p
  • Hypersensitivity,

impaired hand function, unable to return to work

  • Evolve for medical

notes, NCS report, post

  • p notes, Consultant

review

Initial contact 6/52 post op

  • Contact made by t/c
  • Covid-19 Restrictions
  • Explained telehealth
  • Patient consented
  • Email URL and

appointment to patient

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Initial Ax 6/52 post op

  • Attend Anywhere
  • scar hypersensitivity,
  • reduced AROM/PROM
  • Reinnervation

hypersensitivity in MN distribution,

  • reduced hand

function,

  • sleep affected,

increased anxiety

  • Assess for

complications

  • Therapy intervention
  • Education

Follow up 12/52 post op

  • Attend Anywhere
  • ‘I’m 100% happier’
  • ‘absolutely nothing like it

was before’

  • ‘much, much, better’
  • Returned to work, caring

for family, ↓anxiety, improved sleep

  • Rehab prog. progressed
  • Outcome
  • 2 Telehealth sessions
  • No face/face contact
  • Patient to update OT

email at 6/12 post op

  • R CT decompression 4/12

Pros:

Effective for educational and functional rehab Client centred Assess if need for face/face review Patient/staff safety Cons: Pixel quality, wifi connection Extra admin time Objective measures limited

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Resources

  • https://www.ehealthireland.ie/National-Virtual-Health-

Team/National-Virtual-Health-Team/

  • https://healthservice.hse.ie/staff/coronavirus/working-from-

home/virtual-health/virtual-health.html

  • https://www2.hse.ie/services/attend-anywhere/
  • https://www.aota.org/Practice/Manage/telehealth.aspx
  • https://www.aoti.ie/covid/OTA-Telepractice-guidelines-and-

checklist#

  • https://otpotential.com/blog/telehealth-occupational-therapy