Physio appointments by video

By Laura Atherton
Consultant Musculoskeletal (MSK) Physiotherapy Practitioner at Southport and Ormskirk Hospital NHS Trust and Clinical Lead MSK

Elective Care Programme

When COVID hit we had to switch to telephone consultations for therapy outpatient appointments and we could no longer deliver ‘back to fitness’ classes, circuit and education sessions in a face to face way.

We redeployed some staff onto the wards and the referral rate dropped because people weren’t going to GPs.

Then, I heard someone talking about Attend Anywhere for video consultations and I jumped on that bandwagon. For us, pictures tell a thousand words. The rich visual clues add great value to our quality conversations and enhance our patient experience. If I can see someone’s face I can pick up on cues that what has been said is unclear, the person is concerned or the wrong impression has been taken from the communication.

The patient may need to show the clinician a body part to highlight an area of wasting or a shoulder joint that is sitting forward can be seen. This is very hard to describe on the telephone. Attend Anywhere has been amazing. 

The system has a virtual waiting room which greets the patient and informs of any hold ups and offers assurance, promoting a good patient experience. 

We started off small scale, we didn’t have any iPads or laptops but with help from our IT colleagues we managed to get some iPads.
It was clunky at first as patients had to type a link into the web browser which they struggled with but then our IT colleagues created a hyper link in the patient’s email or text message so they can just click on the link and then they’re in.

A few patients advised they didn’t want to do video and there was an assumption made it was because patients weren’t very techy. I decided to look into the evidence of this and when patients were asked, I was really shocked to find that a proportion was because they didn’t like seeing themselves on the video. Attend Anywhere has the functionality to solve this and so we did and we show patients how to turn off their own video.  

Our appointment letters include advice on how to prepare for the Attend Anywhere appointment, including what to wear; sometimes people would come wearing a big jumper when we needed to assess a shoulder. It may be helpful to have a family member in the household with you, to hold up the camera to show the body part. 

Attend Anywhere has a pre-appointment test functionality. The test tells patients if the wifi signal isn’t good enough. The patient can then phone us back and we can immediately convert the appointment to telephone. This takes away the worry about what happens if the technology doesn’t work. 

If a patient needs a hand splint we now send a piece of paper in the post which shows hand prints/grids. The patient can place their hand on over the video. We can give prompts on positioning it and get a more accurate size and better fit.

We can share the screen, for instance to show an X-ray of a knee and its wear and tear and let them know it is completely normal, it’s what you would expect and there is no cause for concern.
 

Virtual first

Everyone is now offered a video consultation first and if they don’t want that, then we go for telephone; and we make a clinical decision after that, which is also based on risk assessment, on whether we bring in the patient for a face to face appointment. 

With our current modelling our plan is to be seeing about 10-15 per cent of our total weekly referrals face to face, which is a considerable reduction in physical attendance. 
 

Attend Anywhere is really good for us to get an amazing assessment and fortunately we can also go on and offer treatment as we already had a number of digital resources that we could use, including an app called Physitrack through which a patient is prescribed exercises. 

If someone is struggling to do an exercise we have prescribed they can send their clinician a direct message. It comes straight through to the clinician’s email and the exercise can be modified without needing further appointments. 

I can look at someone’s compliance through the week and say keep going with that; or you seem to be managing that really easily, let’s make it a little harder – and the patient doesn’t have to come in but the assurance, overview, prompt and care continues. 

Then we found out we could use our trust’s YouTube channel and we uploaded our patient education classes there. Now we are looking at live streaming our classes and education sessions. 

Attend Anywhere will only support four people at once; Zoom isn’t safe enough for our information governance; so we have worked out we can use Microsoft Teams and carbon copy the link to the patients. It means we can have the same size of classes as before, 16 to 18 patients – live streaming in the sessions. 

We started using Physitrack about two years ago but found that many clinicians reverted to paper as it seemed easier. But then because of COVID and remote working that all changed. There were probably three or four clinicians using it regularly pre COVID, now all 36 are using it.

Physitrack enables us to look at the clinicians’ usage so there is always a bit of friendly competition and we’ve actually published a league table showing who the top user is and where everyone else ranks!

You can upload your own content with your own logos to Physitrack; it isn’t cheap but it is really good. We can upload education resources, including videos of classes.

Clinicians have found that the more they use it, the better and faster they are getting at it and they are using it more and more. Sometimes people just need a little push!
 

Virtual first is the future for our service. We have not taken away the hands-on service; but we are no longer seeing people who don’t need to be seen face to face. 

Based on the previous rate of change I think it would have taken us many years to achieve this and it has taken us just six weeks.
 

Previously patients advised they would have to take half a day off work for an appointment; or a full day if assisting a family member/ friend who needs care and reassurance before and afterwards.
 

The lessons I have learnt:

It was important that at the start we sat down with our IT team and went through what we needed the system to do for us.

Each time we went live with a new clinician we had a member of the IT team present in the room – not just on the end of a phone, but stood in the room. I would suggest a staggered introduction.

We have to understand that with technology things can go wrong – just yesterday there was a national problem with Attend Anywhere. When that happens I’ve been clear with our clinicians not to mess about, if after five minutes there is a glitch, just go straight to the telephone option. 

Using Attend Anywhere has raised the service’s profile because we have delivered it well and it is nice to be recognised for our good work – even though we have always been this good!

@LauraAtherton10

Story told: 12 June 2020

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