Abstract: Implementation of the European Working Time Directive (EWTD) has not yet been achieved for Non-Consultant Hospital Doctors (NCHDs) in Ireland. Extended scope physiotherapy practice in UK fracture clinics has had success in addressing this issue. Clinical specialisation of a physiotherapist replacing NCHDs in fracture clinic has not yet been trialled in Ireland. This pilot project evaluated the role of an experienced, specially-trained physiotherapist reviewing patients with uncomplicated fractures in a clinic setting for 6 months. One physiotherapist received additional training over a 2-month period. A caseload of 403 patients with uncomplicated fractures and soft tissue injuries were reviewed by the Clinical Specialist Physiotherapist (CSp) in fracture clinic. Patient and doctor satisfaction ratings and patient caseload and waiting times were collected over a 4-month treatment period. Working hours of NCHDs were also recorded. There was a steady increase in patient caseload per week for the CSp in fracture clinic. The discharge rate was 54%. Specialist Registrar hours reduced from 71 hours to 64 hours per week. Feedback from patients and the orthopaedic team was that the CSp was a desirable addition to fracture clinic. With sufficient training and initial supervision, it has been demonstrated that physiotherapists could take on the role of NCHDs in fracture clinic, and this results in an improved and more efficient service. The recommendation was to establish a CSp post in the fracture clinic in Cork University Hospital. The Irish Society of Chartered Physiotherapy (ISCP) and the Chartered Society of Physiotherapy (CSP) recognise the potential for physiotherapists to extend their roles. This report supports these roles and wishes to encourage such discussion.
Keywords: Clinical Specialist Physiotherapist (CSp), fracture clinic, European Working Time Directive (EWTD)
