Health Service Focus

Getting the balance right

NHE speaks to Nova Mullin, a balance specialist at Aintree University Hospital, about a new patient care pathway that has cut costs and waiting times and has now been shortlisted for an award.

When the audiological consultant at Aintree University Hospital NHS Foundation Trust in Merseyside stepped down last year, the other members of the team used it as an opportunity to redesign the way the service operated.

They have now been shortlisted for an award for the way their new fast-track system works, with only 15% of patients now needing to see a consultant, whereas before all patients did. Furthermore, 60% of patients are now assessed, treated and discharged on day one, with no need for a follow-up appointment.

Before, patients with tinnitus, or balance or dizziness problems, had an initial assessment by a consultant, and it was only after this that they were referred on for further appointments or for physiotherapy or audiological rehabilitation. The new service allows the experienced physiotherapists and audiologists, with extended roles, to hold their own one-stop clinics.

Nova Mullin, a physiotherapist specialising in balance issues, with 15 years of experience, is one of the people leading the new service. She told NHE: “When the consultant was retiring, we thought we would be able to see a lot of these patients, because a lot of them never ever need any surgical or medical intervention, and we felt we could take over.”

It’s now been running for nearly a year, and Mullin said it was both cheaper and offered a better service to patients, with less waiting time and, often, quicker treatment.

Mullin explained: “That’s because previously, they might have gone off to audiology, or off to start some physiotherapy, whereas we can do that all in one visit.

“All new patients with a balance problem are seen by both services on day one; they have a joint assessment, they’re here for an hour. One of the most common balance conditions, that we see in at least a quarter of patients, is called BPPV (benign paroxysmal positional vertigo), the most common cause of dizziness in older people. Because I’m there as a physio, I can treat that with a very specialised physio technique, then the patient can often be discharged on day one. The waiting list has gone down, we’re seeing patients slightly quicker, and the number of repeat visits is much lower, because they’re no longer then having to go to wait for physio or audiology, it’s really streamlined that down.

“Such a small percentage of these patients can ever be helped by surgery, so does it really need to be led by a surgeon? Having said that, we have absolutely fantastic links in with our surgeons, so if at any stage we want anything, we can both order scans and blood tests, and anyone who does need surgical opinion gets to see a surgeon very quickly.”

Complex cases are discussed at regular multi-disciplinary team meetings to ensure that all cases are managed appropriately.

A patient survey showed a 100% satisfaction rating, with 90% giving the top mark possible, and the team has also been setting up new support groups to accompany one that has already been running for three years for patients with tinnitus.

The new balance support group, which held its first meeting in November and is now meeting monthly, is thought to be the first of its kind in Britain in the way it balances medical input with a social support network for balance disorder patients. Group members get to hear experts talk about issues like the anatomy of balance, anxiety issues, and how certain drugs affect balance, while also getting a chance to speak with other sufferers.

Tony Kay, who leads on the audiology side, has 30 years’ experience, while Mullin teaches nationally on balance and dizziness.

Two years ago she spent a week in Pittsburgh in Pennsylvania with one of the world experts on dizziness, and she’s on the national committee of ACPIVR, the Association of Chartered Physiotherapists Interested in Vestibular Rehabilitation. The success of the service led to it being shortlisted for the ‘Rethinking the Patient Care Pathway’ prize at the Advancing Healthcare Awards. The results are announced at the end of March.

Mullin feels there are lessons for other NHS organisations.

She said: “It’s a very transferable model. The population is ageing, so the incidence of deafness predicted over the next decade is phenomenal, and the incidence of balance problems is rising with an ageing population. One in four people aged over 65 has a balance problem, and if not sorted out, there are implications for falls leading to a loss of independence, and then further NHS costs. Recent research shows that in a huge percentage of cases of unexplained falls, the person had an undiagnosed balance problem.”

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