Burns Specialist Physiotherapy Outpatient Service

1. Burns Specialist Physiotherapy Outpatient Service Nigel Smith – Northern Burn Care Network AHP Lead Louisa Boyd – Burns Specialist Physiotherapist

2. AIM Demonstration of a transfer/teaching physiotherapy session with a patient who is being discharged from the burns outpatient service at Pinderfields Regional Burns Centre (RBC) to a District General Hospital (DGH) local to their home

3. Patient • Martyn • 61 year old male • 21/07/11 10:15pm Gas explosion at patient’s home • No first aid at scene • Seen at local A & E department • Transferred to RBC in the middle of the night

4. Patient • 11.5% TBSA burns to face, forearms and both knees • Mixed depth with extensive swelling especially the right hand • Not deep enough to expose the extensor tendons • 27/07/11 - Debridement of burns to hands and forearms and SSG (sheet to hands and mesh to forearms).

5. Physiotherapy • Pre-op – stretches with pain control, education & elevation • Splints for both hands • Post-op – as pre-op with increased use of upper limbs as dressings allowed

6. Physiotherapy • 05/08/11 - Discharged from RBC inpatient to outpatient PSDC • 18/08/11 - Fully healed & discharged from PSDC • Ongoing Physio and OT at RBC as out-patient

7. Telemedicine – Potential Patient Benefits Earlier transfer to local DGH for outpatient physiotherapy: • Enabling patient to be treated earlier closer to home with more confidence in provider source • Reduced travel cost - 260miles (Grimsby to Wakefield and return) 2 visits per week = £40 per week fuel.

8. Telemedicine – Potential Patient Benefits • Reducing travel time – 6 hours total travel time per week (not including treatment time) • Cost and time of someone to drive patient to RBC • Close to family support network

9. Telemedicine – Potential Physiotherapy Service Improvements • Earlier transfer of care of patient to local DGH enabling other patients access to regional burns beds • Physiotherapist at DGH able to SEE treatment session and wound before receiving patient. • Physio at DGH provided with increased confidence with manual techniques and enhanced guidance with wound reviews during treatment sessions

10. Telemedicine – Potential Physiotherapy Service Improvements • DGH would have daily access to visual advice/education/support • DGH could link into teaching and training sessions regionally without the need for travel costs and time • Less need for patient to travel for review at RBC allowing treatment time for other patients • Reduce amount of patients failing to attend appointments due to reduced travel costs and time • Network wide in-service training

11. Telemedicine – Physiotherapy Financial Benefit • Outreach travel saving of £60 per visit • Outreach service cost of £62 per visit Average cost to Trust of travel and time per patient visit = £122

12. Telemedicine – Physiotherapy Financial Benefit • Telemedicine ¾ hour max per treatment/teaching session • Potential to meet an unmet recognised demand out of the current outreach resource

13. Summary • Beneficial for patients; saving time and money, earlier discharge from RBC & closer to family • Ideal model of treatment to outreach large rural area • At present no physiotherapy system in place to monitor patients discharged to DGHs

14. Summary • Support for DGH staff for burns patients • Physiotherapy Burns Service development • Opportunity for teaching • Financial cost savings in travel and time for staffing, and increasing staff productivity

15. Questions? Thank you for listening