Effect of reducing physiotherapy referrals from care homes on waiting lists through health promotion, physical activity, and falls prevention.

This is an ongoing SusQI project as part of the South Warwickshire Green Team Competition 2023 by the Community Physiotherapy Team. 

Project Aim:

• reduce physiotherapy referrals from care homes by 35% through engaging care home residents in home exercise programmes.
• improve quality of life for care home residents
• reduce waiting times for referrals
• reduce carbon emissions associated with appointment travel
• save money and staff time.

Results: 

Patient Outcomes: There are projected potential clinical impacts for care home residents based on evidence-based studies, including improved overall wellbeing, reduced fall-related referrals, and improved quality of life. There is also potential for wider population benefit as change would be implemented across other care homes within Stratford-Upon-Avon and Warwick. A reduction in referrals may improve waiting times for other patients. 

Environmental impact: With the programme implemented across all care homes and a 35% reduction in referrals achieved, a potential saving of 1,175 kgCO2e per year, equivalent to driving 3,470 miles in an average car is anticipated.

Financial Impact: With a 35% reduction in appointments (38.36 appointments per month) the physiotherapy team would save 57.6 hours, or 7.7 days of staff time per month to dedicate to higher value activity. Based on a cost of £144 per one-to-one appointment, this equates to a saving of approximately £5,524 per month, or £66,286 per year.

Social impact: With a health improvement for patients, care home staff may save time as residents require less support and referrals. Seeing patients engage more in exercise and build confidence may improve staff wellbeing. With care home staff implementing HEP’s there are potential positive or negative impacts – staff may enjoy learning, empowerment and taking on a new role/responsibility, or may feel this is a task added to add to already demanding workloads.

Clinical impact: With a 35% reduction in appointments the physiotherapy team would save 57.6 hours, or 7.7 days of staff time per month to dedicate to higher value activity and implementing our preventative interventions. This reduction could increase the efficiency of the physiotherapy service more broadly.

2025 Update:

Measures

• Total referrals received
• Average waiting time (days)
• Total face-to-face (F2F) visits
• Total mileage 
• Total mileage expense claim
• Social impact on staff
• Patient’s quality of life (QOL)

Changes

• In conjunction with Warwickshire County Council, we organised a webinar for social care workers in June 2024 and uploaded this resource onto the Social Care Information and Learning Services (Scils) portal in the same month. 
• Alongside the therapy triage clinicians, we developed a new care home referral document in October 2024.

Achievements and results

• Total number of referrals was reduced by 33% and 31% in Stratford and Warwick, respectively.
• Average waiting time was reduced by 33% and 70% in Stratford and Warwick, respectively.
• Total F2F visits was reduced by 54% and 46%  in Stratford and Warwick, respectively.
• Total mileage driven was reduced by 61% and 62% in Stratford and Warwick, respectively.
• Total mileage expense claimed was reduced by 61% and 62% in Stratford and Warwick, respectively. 
• Carbon savings (0.3386kgCO2e per mile driven): 874 and 1368 in Stratford and Warwick, respectively.
• Financial savings (£144 per appointment):  £28,512 and £46,224 in Stratford and Warwick, respectively.
• Time savings (90 mins visit): 297 mins and 482 mins in Stratford and Warwick, respectively.
• Care staff reported improved knowledge, ideas, and skills, increased knowledge of equipment, better understanding of the importance of exercise, and key contact information.

Points Care Staff Have Put Into Practice Since Webinar

1. Audits of mobility equipment.
2. Encouraging individuals to increase walking.
3. Set small achievable steps for clients.
4. Set up hydration sites.
5. Reviewing activities to increase exercise sessions. 
6. Start walking frame decoration competition. 
7. Adding mobility aids to the care plan and audits. 
8. Adapted induction, looking to introduce video.

Future considerations and learning

• Collect data for the same months in 2025 to assess if impact has been sustainable.
• Making every contact count
• Provide further learning opportunities for social care workers based on feedback received.

Conclusion

This project aimed to enhance residents’ participation in physical activity, in turn improving their health, quality of life, and wellbeing through system-wide changes to care home organisational, environmental, and working practices. 

Although there were challenges associated with working in care homes, this project produced significant benefits and was affordable.

 With a growing number of elderly residents in residential care homes, this project was not only important for environmental sustainability, but also financial, social, and clinical sustainability.

Click here for more information on the Green Team Competition (including organisation impact reports).