Team helps prevent hospital stays with rehabilitation at home

Physiotherapists are supporting patients with their rehabilitation at home rather than in hospital as part of Swansea Bay’s virtual wards.

The virtual wards provide wraparound support in the community to people with complex health and social needs.

Rather than a ward being made up of hospital beds, the patients’ own beds become part of a virtual ward, meaning they still receive the same level of care but in the comfort of their homes instead of a hospital.

Pictured: Virtual ward physiotherapists Paula Boughey and Gail Havard, clinical lead physiotherapist Sheree Breckon and virtual ward physiotherapist Bogdan Pancu.

A multidisciplinary team comprising health and care professionals, such as doctors, nurses, pharmacists and therapists, discuss how to plan and manage each patient’s care, ensuring face-to-face assessment and intervention is carried out.

Virtual wards run within the health board’s Local Cluster Collaboratives (LCCs) – Afan, Bay Health, City Health, Cwmtawe, Llwchwr, Neath, Penderi and Upper Valleys – with one based in each LCC.

Physiotherapists were introduced to the virtual ward primarily to support the Fracture Discharge Service, by helping patients with their rehabilitation at home instead of in hospital.

The team help those who don’t need to be admitted to hospital, as well as those who can be discharged earlier with support from the virtual ward.

Sheree Breckon is the clinical lead physiotherapist who oversees the virtual wards’ physiotherapists.

“It had been identified, that with the addition of physiotherapists, the virtual ward could provide support to patients who had sustained a fragility fracture that did not require admission for surgical or inpatient intervention,” she said.

“And also, patients who had required surgery that could be discharged home sooner.

“Having physiotherapists as part of the virtual ward has enabled these patients to be supported at home at the earliest, safest opportunity.

“It has allowed the hospital to be able to discharge patients earlier and also avoid admission for those patients who may have previously been admitted for their ongoing care and rehabilitation.

“For our patients who are frail, we know hospital is not always the most appropriate place to be following a fracture due to the risk of infection and deconditioning, and with the extreme pressure on our secondary care services this pathway has provided a safe, alternative option.”

Each patient will be seen by a physiotherapist at home for an assessment to establish what difficulties they are experiencing as their fracture heals.

The team then work to ensure patients keep active and mobile, while also supporting their recovery through advice, education, range of movement and strength exercises.

Sheree added: “The main goals are to restore mobility, range of movement and strength.

“Physiotherapy is important following a fracture to aid patients in optimising function, minimise any long-term impact and to return to their normal activities as soon as possible.

“The patients we see with fragility fractures are often as a result of a fall, so although we are involved in the initial recovery, we work in conjunction with the multidisciplinary team in the virtual ward, such as occupational therapists, to help reduce the risk of a future fall.”

Following the development of the Fracture Discharge Service, the team have also worked with specialist physiotherapists to identify a new way of helping patients who have experienced chest wall trauma.

Staff have introduced a new pathway where patients are assessed to see whether they can receive their care at home instead of being monitored in hospital.

“The pathway is for patients who have had a blunt chest wall trauma, such as rib fractures, that would be at risk of developing pulmonary complications, particularly in the first 48 to 72 hours,” Sheree said.

“This type of injury is often associated with significant pain which can cause breathing difficulties and reduced mobility which may lead to further complications.

“Historically these patients would have been admitted for monitoring during that time.

“But with our new pathway, we have been able to identify a cohort of these patients who are safe to go home under the care of the virtual ward so they can be monitored and receive any intervention there instead.

“As physiotherapists, we are trained in providing respiratory physiotherapy which involves educating patients on how to best reduce the risk of developing complications through methods such as breathing exercises and supported coughing.

“Due to the multi-professional team within the virtual ward and support from our colleagues at Morriston Hospital, we can reduce the risk of pulmonary complications that could occur from the chest wall trauma without the need for the patient to be admitted to hospital.”

The virtual wards’ wider multidisciplinary team has also benefited from the physiotherapists’ involvement, as staff have gained knowledge and advice they can share with patients.

Sheree added: “We have been able to provide advice and education to the wider virtual ward team and upskilled colleagues in areas of physiotherapy that they could safely deliver.

“We have provided training to the occupational therapists to allow them to use those skills with the patients we aren’t seeing.”

Dr Elizabeth Davies, Consultant Geriatrician and Clinical Director for Elderly Care at Morriston, works alongside the virtual ward team.

She said: “Since the introduction of the fracture discharge pathway, more than 400 patients have benefitted from the service, receiving comprehensive wraparound care from the virtual ward teams including targeted rehabilitation from the physiotherapists.

“The service has received overwhelmingly positive feedback from patients and their carers/families and has helped to avoid admissions and facilitate earlier discharges.

“The physiotherapy team are to be congratulated for their excellent work to enable patients to recover from their injury in their own home and regain their confidence and independence.”