Physiotherapy Urogynaecology Rehabilitation Pathway: the PURE pathway

Author(s): C. Broad - Pages: 16–17

Abstract

A collaborative service development was undertaken by the Department of Obstetrics and Gynaecology department and the Women’s Heath Physiotherapy service of Cardiff and Vale University Health Board, Cardiff, UK. This proposed a redesigned pathway for all urogynaecological referrals. A fundamental problem with the existing service was that women experienced an 11-month wait to see a consultant from the time of referral, and at least 50% of them were then referred for physiotherapy, entailing a further 5-month wait before conservative management of their problem commenced. It was proposed that, if the patients were triaged from paper referral according to specific criteria and then referred directly for physiotherapy, it was estimated that a large percentage of these women would not require a clinic appointment with a consultant. Because of waiting list targets and a lack of Welsh Assembly funding, the consultant backed this venture, and it was agreed that it would be funded, piloted and audited for one year. On completion, 450 patients had been assessed and treated within the Department of Physiotherapy and 56 (12%) had been referred to the clinic for a consultant intervention. This saved valuable clinic time and substantially reduced waiting times to 3 months for consultant appointments and 4 weeks for physiotherapy. A comprehensive database was developed that demonstrated excellent patient outcomes when scrutinized. This piece of work subsequently won local awards and was accepted for poster presentation by the International Continence Society for its 2010 Annual Conference in Toronto, Canada. Finally, the women’s health physiotherapy team received permanent funding and the second stage of the development is now being introduced. All urogynaecological patients are to be triaged and assessed by a physiotherapist before consultant referral, which will require additional funding, and it is hoped that another full-time band 7 post will be created. The Chartered Society of Physiotherapy (Laycock et al. 2001), Association of Chartered Physiotherapists in Women’s Health (ACPWH 2007), Royal College of Obstetricians and Gynaecologists (RCOG 2003) and National Institute for Health and Clinical Excellence (NCCWCH 2006) guidelines have been adopted.

Keywords: audit, funding, outcomes.