1. For further information please contact: alex.fisher1969@btinternet.com
An inter-service cost & time effective exploration of multipurpose hand splinting
A Fisher (1) , S Wilson (1), H Masterson (2), J Litler (2), S Meggs (3) & P Mottershead (3)
1 – Community Rehab Team, Nantwich, Cheshire. 2 – Specialist Stroke Team, Crewe, Cheshire. 3 – Medical and Stroke Unit Occupational Therapy, Leighton Hospital, Crewe, Cheshire.
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DOG HAIR, TIME, THE KITCHEN SINK, KETTLE, COMPLIANCE ……. The challenges to creating a wearable & durable splint in a community setting are multifaceted. We needed to change the way we were working to keep up with the demand and increasing complexity in our neurological referrals. It’s a call to alms that’s facing all community services around the world – how can we meet the ‘rehab’ expectations of such vast numbers? (Kendall et al, 2009). This is our small piece of the jigsaw.
Inspired by the latest COT Guidelines (College of Occupational Therapists, 2015) & feeling that a fresh look at the process would benefit patients across all local services including our acute and stroke pathways – a working party was convened to work out strategy and take a closer look at the evidence.
Our initial activity was to scope for the demand across services but also the cost effectiveness of an ‘off the peg’ solution –v- a tailor made splint.
Approx splints made over all services (not including hand clinic or stroke unit). At least 50 of these made in the community. Average time to make a tailored resting splint (in community) was 1+ hour/s by Band 7/with assistant. To this we added materials/fuel/travel and follow up visits. The contract cost of ‘off the peg’ splints was equivalent (if not slightly cheaper) and together we concluded that ‘off the peg’ could be a viable alternative. Additionally many of the ‘off the peg’ varieties can be machine washed and remoulded using just a hair dryer.
We then sourced and agreed on suppliers. Suppliers were keen to provide assessment kits and product at competitive prices which further drove costs down.
Whilst critiques argued that we might lose our clinical skills – our group returned a resounding ‘no’, as we all felt that knowledge and reasoning is still used when prescribing ‘off the peg’. In fact, the whole process has been a great CPD experience. We are now all far more familiar with the evidence and outcomes we should be looking for. Working across specialities, whilst time consuming in its organisation, has led to greater understanding of each other’s areas and a more realistic and holistic approach to the project.
The project is nearly complete. Providers are now in place, but so to is a standardised pack to assess, capture and audit the new process. We are also considering how we inform one another electronically if a splint is issued in one provider area and then becomes known to another so that treatment can continue and outcomes can be followed up. This latter process is really important to avoid duplication (again promoting cost & time effectiveness), but also to increase knowledge of the long term usage of splints (of which there is a dearth in the literature) as well as promote the national and local drivers for integrated care (Central Cheshire Connecting Care Board, 2014).
References: KENDALL, E., MUENCHBERGER, H. and CATALANO, T., The move towards community-based rehabilitation in industrialised countries: are we equipped for the challenge? Disability and rehabilitation, 31(26), pp THE COLLEGE OF OCCUPATIONAL THERAPISTS AND ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS IN NEUROLOGY, Splinting for the prevention and correction of contractures in adults with neurological dysfunction - Practice guideline for occupational therapists and physiotherapists. CENTRAL CHESHIRE CONNECTING CARE BOARD, A Transformational Approach to the Integration of Health & Social Care in Central Cheshire 2014 – 2019 (Accessed at May 2016).
An audit at approx 6 months into the project going live is planned but the benefits noted so far are:
Greater compliance & comfort feedback from patients “They are wonderful! Such a difference, really comfortable and soft to wear on my skin. The finger spaces are a work of art”
Reduced carer training
Less follow up visits to ‘tweak’ post fitting
No more washing up bowls, kettles and dog hair! Equalling a happy and cost effective community OT