Areas of variation between clinics, barriers and opportunities for improvements identified by staff
| Areas of variation between clinics | ||
| Subtheme | Variation | Clinic staff excerpts |
| Scheduling assessments | "…I suppose it’s probably a random [assignment), you have got one [client] already you [someone else] takes the next one, just so that we are all getting an equal share of work. And then sometimes I suppose it depends on if it [client] comes from the hospital, they usually give you an explanation of how the fall happened…" | |
| Assessment | (V1) (V2) | "You use your own clinical judgement to an extent, yeah. But I suppose you would always err on the side of caution as well and do what the paper [assessment form] tells you to do.” “…so we would always do a Berg score which is a balance score…, because resources are so limited in Turners Cross and there is no point in having someone seen here and then they are on a waiting list for possibly another month or 6 weeks just to get a Berg” “So we’d have a meeting then at the start of every kind of FRAC morning….come back then to discuss [summary sheets)” |
| Onward referrals and follow-up interventions | (V3) (V4) | "I suppose when we were all here together, we kept the referrals in-house, we just have our own list here, our intervention list. Yeah, it was easier for us to manage it that way rather than generating all these referrals [for other services)” "extra time [for the follow on intervention] with the intention being that we were stopping a huge referral from risk assessment clinic into the community. So, she [manager] was giving me intervention time, but it was also to eliminate the kind of extra waiting times on the community side of things.” |
| Barriers and opportunities for improvements | ||
| Subtheme | Barrier and area for improvement | Clinic staff excerpts |
| Referral process | (B1) (I1) | "…The vast majority of referrals that come through its just falls, history of fall, there is so little given to us…often with the referrals you would get little to no information …" "There is meant to be a level 1 screening form that everyone is meant to fill out [for referral into fall risk assessment clinic), and that was meant to come into play, nearly three years ago, and they are still tweaking it, and it has not been used. I only read it for the first time the other day when I was over in the office, and, if you read that [referral eligibility criteria] and if that was the gold standard of a referral [into fall risk assessment clinic] then you would get appropriate referrals…” "I think it goes back to the referrals maybe aren't filled out adequately, it’s difficult to pinpoint where that goes wrong. I think the referrals and the triage probably that’s where the information needs to be improved a little bit yeah…” |
| Inappropriate referrals to the fall risk assessment clinics | (B2) | "…we get a few inappropriate referrals which didn't meet the falls risk criteria or may have never had any falls in the past but have managed to come to us anyway, we would usually contact her (falls coordinator) to see what we need to do next….We have tried to nip it in the bud, and the nurse that we had on the team was quite good with that because she was good at saying no, that’s not an appropriate referral. But that is what our fear is…” "I think at the beginning when the fall risk assessment clinics started that was my impression that the focus was to prevent the falls, to get at this at an early stage… It tends to be older, more debilitated people, I suppose. We wouldn't get that many, as I say 65-year-old or younger…We don't seem to be capturing those” |
| Scatter referrals | (B4) | "…it can be frustrating then if you see people referring to the fall risk assessment clinic, with falls not be their primary concern. But they are using the clinic to get to physio or OT quicker…” |
| Assessments skills | (B5) | "there is confusion at the moment with the cognition tests because obviously, you need the training in the one we would have done all the time, so that is a bit up in the air at the moment.” |
| Onward referrals ‘out of area’ | (B6) | "… if the patient is out of area, they can do an intervention… But they cannot take them on their caseload if the patient requires continuous [specialised] care…then I need to give that to the OT in the(client’s)area.” |
| Administrative support and data management | (B7) (I3) (B7) | "…there is a huge amount of duplication in everything…I suppose then we do see the same people or they will be on a different list for other things you just wonder how much duplication is there and I suppose it all comes back to a lack of proper data.” "we have an excel sheet, and basically after each session, I email XXX the outcome of what the chosen pathway was for the patient, was it physio, was it OT, will they be getting OT in the intervention group, will they have nursing needs in the intervention group. We have a section in the excel sheet for each one.” "you are wondering at the end of it all, how do you know if the patient has been seen or treated or who has taken ownership of the patient. That was a huge issue, is that basically they come, and then; unfortunately, we feedback to the office, and we don't really know what is to come. The big issue is that there is no, unfortunately, there is no communication with falls risk assessment clinics and community services” (Clinic F, ?) |
B, Barriers; I, Improvements; V, Variation.