Implementation of an advanced practice physiotherapy vestibular assessment clinic within ENT specialist clinics.

Abstract

Aim: There was a 203% increase in the number of patients with dizziness/vestibular disorders referred to Ballarat Health Services (BHS) outpatient services between 2010-2015. Average wait time was 383 days for assessment in Ear, Nose and Throat (ENT) Specialist Clinics. Geographical separation of ENT and Allied Health Outpatient Clinics led to duplication of referrals, delays in diagnosis, treatment and rehabilitation. Methods: Methods: A pilot study of a Physiotherapy advanced practice model of care for the assessment of patients with vestibular symptoms. Participants were patients referred to ENT department or Allied Health outpatient services who satisfied the PVAC inclusion criteria. Participants underwent an audiology assessment and comprehensive vestibular Physiotherapy assessment. Discussion with ENT medical staff occurred as indicated. Data was collected from medical records for all participants and included: referral patterns, waiting times, provisional diagnoses, need for further investigation/specialist review and time to commence rehabilitation. Surveys were used to collect Patient experience data. Results: Results: 54 patients attended the clinic which was run fortnightly from October 2016 until September 2017. The average wait time for patients versus referral to the ENT department reduced from 383 days to 82 days. 5 patients required further investigation (CT/MRI) and 1 patient require ENT intervention (prescription of medication). The patient satisfaction rating for the PVAC was high with an average of 9.89/10 rating for positive experience and 98% of patients reporting that they were "very satisfied" with their assessment in the clinic. Staff satisfaction ratings were also very high. Conclusion: Conclusion: This clinic uses an important existing resource - Physiotherapists with advanced skills in managing vestibular disorders. It decreases the demand on more traditional and costly medical specialist clinics and provides more timely assessment and commencement of appropriate rehabilitation. The advanced practice model of care provides an accessible and sustainable service.