Lymphoedema Management in Occupational Therapy
4 December 2014 Last updated:
8 December 2014
Lymphoedema Management in Occupational Therapy
Sydney Local Health District (SLHD)
This approach is focused on facilitating early intervention with improved awareness of the chronic condition and referral pathway. Solutions aim to empower patients with the ability to independently self-manage with support of an integrated care approach with community health and EnableNSW to minimize long episodes of care with the outpatient service. Improved efficiencies with a service agreement and planned patient journey aim to help meet the demand of the service and reduce the wait time for treatment.
Download a poster about this project from the Centre for Healthcare Redesign graduation, December 2014.
To deliver an equitable, timely and sustainable treatment/service to patients with the condition of lymphoedema who are residents of Sydney Local Health District.
- Improved patient journey through timely assessment and treatment
- Equitable and sustainable district service through an early intervention focus
- Improved access to services with a streamlined referral pathway and community follow-up
- Recognising occupational therapists are clinical specialist for providing clinical excellence in the treatment of lymphoemdema
Lymphoedema is a progressive chronic condition that can have a deleterious effect on patient’s physical and psychosocial health. The demand on the Lymphoedema service in Sydney Local Health District has increased and is predicted to continue. The demand has increased due to several factors including the increased recognition of the diagnosis of lymphoedema, increase in secondary lymphoedema due to increase in surgery, cancer and radiation treatment, and greater awareness of the benefit of managing lymphoedema to prevent recurrent cellulitis.
In 2013, the services provided over 2500 occasions of service for outpatients however this did not meet the demand. The waiting times are not clinically appropriate to achieve the desirable patient outcomes according to best practice guidelines and differences in waiting lists, means access to services are not equitable. Senior clinicians with specialised training are a small critical mass in the department and periods of leave impacts detrimentally on the service provision.
This condition often becomes costly from a health service and productivity perspective when the condition is established and is a chronic condition. There is an increase in hospitalisation, longer treatment times and complexity of treatment type. Untreated or mismanaged lymphoedema can decrease a patient’s level of function and loss of occupational roles.
The diagnostic phase highlighted issues based on the demand of the service, difficulty with access, unclear referral and booking pathways and patient’s requiring long episodes of care.
ImplementationSolutions include establishing a service agreement for this district wide service, with plans to develop a referral pathway with a central intake. This includes:
- the use of Information and Communication Technologies (ICT) to manage referrals, waiting lists, scheduling appointments, contacting patients, updating referrers and documenting clinical care
- establishing a Health Pathway with the Inner West Medicare Local to streamline referrals
- developing a SLHD website providing education to referrers and patients including an information package
- offering referrers an in-service program and developing a group education session to replace individual education sessions
- trial alternative sources of donning aids and readywraps compression garments to reduce cost to patients
- requesting a pilot with EnableNSW to address existing problems with ordering and supply of garments
- an application to the Integrated Care Funding Submission for an extended lymphoedema service that provides support to achieve long-term self-management in the patients home
- information technologies to provide ‘alerts’ to prompt patient schedule reviews
- direct patients to local services where they exist and support local occupational therapists will be explored.
SLHD Occupational Therapy Lymphoedema services operate at Royal Prince Alfred Hospital (RPAH) and Concord Repatriation General Hospital (CRGH), providing support to district community nursing. Services available to Canterbury Hospital and Balmain Hospital inpatients are pending available patient transport to CRGH and RPAH.
Several outcome measures have been established to ensure close monitoring of all solutions. Objective measures for the project include evaluation of the time period for a patient to receive an initial assessment and treatment, the overall patient experience and the number of patients ‘at risk’ of lymphoedema who receive education.
Measures for specific solutions include improved patient and staff awareness of the condition, referral pathway, improved patient attendance to outpatient appointments, reduced length of patient episodes of care, improved number of referrals that meet the referral criteria and improved communication with referrers.
Changes to data collection have been implemented to allow measures to be consistent across sites.
- Sydney Inner West Medicare Local
- Australasian Lymphology Association
The project was undertaken via the Agency for Clinical Innovation’s Centre for Healthcare Redesign program.
The challenge of addressing the increasing demand of the SLHD lymphoedema service and the difficulty referring patients to their local lymphoedema service is an issue which needs to be addressed on a larger scale.
The lack and inequity of public lymphoedema services is starting to be recognised across Australia with the recent establishment of the Lymphoedema Action Alliance group supported by the Australasian Lymphology Association.
The implementation of solutions within the scope of this project aims to assist in meeting the growing demand of the service in SLHD, however it is a long term issue which needs to be addressed across NSW Health and Australia.
Challenges have also included ensuring consultation about solutions is communicated to all stakeholders prior to implementation, recognising cross-site differences in management and approaches to patient management, as well as the limitations of implementing efficiencies with existing human resources.
Sydney Local Health District
Phone: 02 9767 6270
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