Examining the details
In many clinical areas of physiotherapy the difference between adequate care and great care is attention to detail. Without attention to detail in the administration of a clinical test, the performance of an intervention, and reassessment of the effect of intervention, results can be misinterpreted and the most effective treatment not delivered. Providing good clinical care in a system that is patient-centred and designed with safety in mind, is the essence of the framework for safety and quality championed by the Australian Commission on Safety and Quality in Healthcare.
When we look at the principles that underpin the safety and quality agenda in physiotherapy practice, we need to consider all of the domains, not just 'doing no harm'. Other relevant domains include patient access to care, as well as the appropriateness, effectiveness, continuity, responsiveness and acceptability of care. So, as physiotherapists, what is our role in contributing to a safe and high quality outcome for our patients?
At a system level, the contribution of individual physiotherapists will depend on the setting that they work in. In most public settings there is an institution-wide approach to safety and quality. A physiotherapist's contribution may include aspects such as risk identification, process improvement and working with other stakeholders about information flow during handover of care.
In the private setting, the approach to safety and quality is more variable. Some larger practice groups have a comprehensive approach (as do some smaller clinics). A number of clinics have utilised the practice accreditation program (qip.com.au/physiotherapy) as a mechanism to improve their clinical and business systems.
At an individual level, most physiotherapy services in Australia are delivered safely. When you consider that roughly 26 million physiotherapy services are delivered in Australia in the private sector each year, there are relatively few complaints against physiotherapists.
But there are two primary issues evident in complaints against physiotherapists that I think are worth reflecting on. Almost all complaints that are upheld have these two themes: the issue of consent to treatment (including discussion of risks versus benefits of proposed treatment) is not perceived to have been fully discussed; and there are inadequate clinical records.
Keeping good clinical records is a fundamental part of physiotherapy treatment. But the experience of surveyors who accredit physiotherapy practices, and those involved in the defence of claims against physiotherapists, highlights that often clinical recordkeeping is sketchy. There have been several findings by registration boards relating to conduct claims against physiotherapists in which record keeping has been identified as a significant issue. Several of these have resulted in conditions being placed on the registrations of physiotherapists to practice.
I encourage all physiotherapists to reflect on the way in which they handle informed consent to treatment in their practice, and consider the way in which they keep clinical records. And most importantly, keep delivering safe and high quality physiotherapy services to the Australian community. It’s the attention to detail that matters.
MARCUS DRIPPS, APAM
APA National President
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