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Published on: August 14, 2018
Advanced clinical practice in closed hand trauma: Codevelopment of a hand therapist--led fracture clinic
Katia Fournier1, Lisa Newington2, Lily Li3
1Hand Therapy, Imperial College Healthcare NHS Trust, London, UK.
Background:
Closed hand trauma is prevalent, and its management is healthcare service intensive. In the United Kingdom, persistent healthcare austerity and challenges of providing care compliant with national guidance are driving innovation in practice. Increasingly, advanced clinical practice hand therapists work in the fracture clinic performing assessment of closed hand trauma and deciding on surgical or nonsurgical treatment options.
Purpose:
Reported is the codevelopment of a hand therapist--led closed hand trauma clinic, aiming to promote practice development internationally.
Study Design:
Service evaluation.
Methods:
With "Innovate at Imperial," charity funding the Enhanced Pathway for Injuries that are Closed and Complex (EPIC) was developed. This article describes the pathway and reports on (i) the codevelopment using focus groups with patients; (ii) a quantitative evaluation of the pathway; and (iii) a qualitative exploration of patient experience of EPIC using satisfaction questionnaires and a focus group.
Results:
Initial focus groups revealed that patients valued early intervention, expert opinion, kindness, personalized care, and being included in the treatment decision-making. They trusted therapists to deliver care. Of the 212 patients assessed in the first 9months, 75% were referred to hand therapy, 22% were discharged, and 4% referred for surgery. Active range of motion at discharge was excellent or good in 79% of patients, pain absent or minimal in 81%, and Patient-Rated Wrist and Hand Evaluation score 25 or lower in 59%. Patients referred to hand therapy required two appointments (median). Therapists attained clinical proficiency over 3-6months, assessed by the number of cases queried with hand surgeons. Patient satisfaction with the pathway was high and no patients requested to see a hand surgeon instead of a therapist.
Conclusions:
Therapists can safely and efficiently lead closed hand trauma clinics. This codeveloped pathway can serve as a model for other centers.
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