Three therapies, and the wait that does the damage

Referral queues that separate triage from allocation, a waiting list that counts days on every row, and a dysphagia register that says whether the aspiration risk is silent or overt.

1 Three professions, one waiting list problem

Physiotherapy, occupational therapy and speech and language therapy each run a referral queue, a caseload and an outcome measure. What they have in common is that the wait is where the harm happens, and the wait is the thing most systems record worst.

commvita puts the queue first in all three, with the urgency, the source and how long somebody has been waiting on the face of it.

2 Physiotherapy: triage before allocation

Referrals arrive from a GP, a consultant or a self-referral, and each carries the presenting complaint in clinical words: acute lower back pain with radiculopathy; rotator cuff tear, post-surgical at eight weeks. The queue splits by speciality — musculoskeletal, respiratory, neurological, post-surgical — because those are four different waiting lists wearing one name.

Triage and allocation are separate steps. A referral can be triaged and still unassigned, which is the true state of most physiotherapy queues and the one that gets hidden when a system only has “open” and “closed”. Exercise prescription, activity analytics and NICE pathway compliance sit behind the queue.

3 Occupational therapy: the wait, in days

Every row has a wait in days on it and the header carries the average. Falls prevention allocated in five days; a home adaptation still waiting at twelve. The reasons are the OT job in one column: falls prevention, home adaptation, post-discharge, return to work.

Behind it sit home assessments, equipment and adaptations with the disabled facilities grant, vocational rehabilitation and the COPM outcome measure. The equipment and grant work is where OT waits turn into someone stuck upstairs, so it’s held with the referral rather than in a council spreadsheet.

4 Speech and language therapy: a safety register, not a caseload

Twelve on the caseload: four dysphagia, six communication, two voice. The dysphagia four sit on their own safety register, and the column that matters says whether the aspiration risk is silent or overt.

That distinction is the whole reason for the register. Overt aspiration makes somebody cough, and everybody around them knows. Silent aspiration doesn’t, and the first sign is a pneumonia. A ward or a care home needs to know which one they’re dealing with before the next meal, and putting it in a letter doesn’t achieve that.

Communication work covers aphasia, dysarthria, fluency and augmentative and alternative communication; voice has its own pathway; and the RCSLT outcome measures run across all of it.

Where it lives in commvita