An integrated Continuing Professional Development approach to service delivery

Relevance: In a busy out patients department time for Continuing Professional Development (CPD) competes with patient contact in order to meet service requirements. Evidence based practice is supported by clinical guidelines and pathways of care, although uptake can be problematic. To facilitate decisions in practice clinicians need access to relevant information in a timely fashion. Information on management needs to be readily available and embedded within service delivery. Information technology can facilitate service delivery, evidence based healthcare and individual staff development. Purpose: This project aimed to embed pathways of care into the Community Musculoskeletal Service and Continuing Professional Development structure to ensure consistency of knowledge in the management of anterior knee pain. Approach: Using the plan, do, study, act cycle we developed a quarterly CPD cycle with taught sessions, journal club and structured supervision focussing on a key are of service provision. Inservice training sessions were used to review the evidence base and develop consistency in assessment and treatment skills. Journal clubs focused on critical appraisal of evidence that informs the pathway. Structured supervision topics embedded the pathway within individual's clinical practice. Following an audit of lower limb conditions seen in the department we focused on the management of people with anterior knee pain. We developed an integrated knee pathway, which we embedded in our electronic appointments system for ease of access at the clinical interface. The interactive pathway covered the key aspects of assessment and management of anterior knee pain and linked to patient information resources and education group referral criteria within our service. The journal club focussed on evidence for the management of anterior knee pain. The structured supervision topic was based on the integrated pathway for anterior knee pain with clinicians reviewing clinical records to identify management in the light of best evidence. Evaluation: We evaluated the management of thirty randomly selected patients with anterior knee pain against the integrated anterior knee pain pathway across three time periods; 2012, 2013 and 2014. Patient records were reviewed for three key aspects of management; stretching (hamstrings, calf and ileotibial band), recruitment of vastus medialis oblique (static and dynamic) and recruitment of gluteals. Outcomes: The proportion of patients who were managed with stretching increased across the three year period: hamstrings 40% (2012), 53% (2013) and 80% (2014), calf 23% (2012), 37% (2013) and 63% (2014), ITB 10% (2012), 17% (2013) and 67% (2014). The proportion of patients who had static and dynamic exercises increased: static vastus medialis oblique 83% (2012), 90% (2013) and 100% (2014), dynamic vastus medialis oblique 70% (2012), 77% (2013) and 97% (2014) and gluteals 27% (2012), 30% (2013) and 63% (2014). Conclusions: An integrated approach to Continuing Professional Development and service delivery has an impact on the management of Anterior Knee Pain in a Community Musculoskeletal Service. Further study is needed to evaluate any effect on patient outcomes. Impact and Implications: Implementation of pathways and guidelines needs to be facilitated by structured CPD which is embedded within the service.