Quality Improvement Project to improve access to early screening and physiotherapy for infants at high risk of neurodevelopmental disorders
Bibliographic record
Abstract
ABSTRACT Purpose and Setting Recent international guidelines for Early Diagnosis of Cerebral Palsy (CP) recommend the use of specific evidence-based tools and early therapy intervention for preterm infants at high risk of cerebral palsy. Referrals for physiotherapy and diagnoses of CP in high-risk infants discharged from the Neonatal Intensive Care Unit (NICU) at the Chelsea and Westminster NHS trust were recorded as occurring later than guidance recommends. A quality improvement project was initiated aiming to enhance identification of CP, increase provision of early physiotherapy and achieve this within the current physiotherapy staffing establishment. Methods A quality improvement project was implemented. Physiotherapists received training in using evidence-based assessment tools and early intervention. A new pathway was developed including a schedule of screening assessments and physiotherapy for high-risk infants on discharge from the NICU. This included a 14-month pilot of a new physiotherapy outpatient screening clinic. Results Following the pilot, age of referral for physiotherapy reduced from a mean of 11.84 to 4.25 months. All babies were assessed using recommended evidence-based tools including the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination and General Movements. Previously only the Alberta Infant Motor Scales were used. Parent feedback demonstrated that the parents felt supported, valued the relationship with physiotherapists and felt confident to carry out activities suggested by physiotherapists. Conclusion and Recommendations The new physiotherapy screening clinic was effective in increasing access to early physiotherapy and evidence based diagnostic assessments and was achieved within current staffing levels. A business case is being considered to increase physiotherapy provision so intervention can be provided consistently at the planned frequency. It is suggested that other Trusts may also find this model of intervention effective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.149 | 0.121 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.005 | 0.011 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".