Case Background

Mr. A suffered an accident at work becoming caught and picked up by the manipulator of a power press machine. Mr. A was squashed between the manipulator and the conveyor belt of the steel press machine.

He was taken to hospital by ambulance where he underwent emergency surgery, but was later sedated, ventilated and transferred to Intensive Therapy due to developing Septecaemia. He remained on ITU for five weeks and was discharged home after a subsequent nine week inpatient stay.

Mr. A sustained the following injuries and problems:

• Spinal fractures
• Perforated bowel resulting in a laparotomy and de-functioning colostomy
• Abdominal bleeding (retroperitoneal haematoma)
• Left knee injury (meniscal tear and anterior-cruciate ligament injury)
• Significant physical de-conditioning
• MRSA
• Severe psychological adjustment disorder

Medicess Involvement

Overview:

1. Work status – employer contact
2. Telephone triage
3. Medical notes obtained
4. Physical examination
5. Private treatment provided by Medicess and coordinated with NHS services
6. Worksite Assessment
7. Return-to-work monitoring and coordination of vocational services

Immediately upon notification, all parties were contacted for collaborative engagement with the rehabilitation process. Medicess established an in-house multi-disciplinary team based on the clinical requirements of Mr. A, consisting of a Medicess Doctor, Psychologist, Physiotherapist, a regional Occupational Therapist and an Employment Consultant.

Following a Physical Examination, review of the medical notes and liaison with the treating parties, an objective clinical view was established on the best delivery and integration of a treatment programme to advance this gentleman’s care, within, and parallel to the NHS.

The Medicess in-house team worked together with Mr. A, the treating NHS and appointed private Professionals, the employers, vocational services, Solicitor and Insurer to ensure the optimal, appropriate and timely coordination of rehabilitation.

A summary of how the team operated follows:

Medicess Physiotherapist

Liaison with the treating NHS Physiotherapist identified substandard levels of therapy input due to pressure on time and a lack of appropriate equipment / facilities. The Medicess Physiotherapist coordinated the seamless transition of Physiotherapy to an appropriately skilled Physiotherapist with the necessary equipment and facilities.

To aid continuity and optimise carry over between sessions, exercise aids were provided for home use.

Once rehabilitative aims were met for one-to-one Physiotherapy, through liaison with the treating GP, the Medicess Physiotherapist instigated a referral to a structured GP Exercise Referral Scheme.

A review with the treating private Physiotherapist was scheduled to ensure the continuity and progression of Mr. A’s ongoing attendance to the gym upon completion of the exercise referral scheme.

Medicess Psychologist

The Medicess Psychologist coordinated and directed private Clinical Psychology as there was significantly delayed provision on the NHS. Treatment was coordinated to reconcile the incident, the colostomy, promote acceptance and then integrating vocationally orientated goals.

Medicess Doctor (Occupational Physician)

In addition to liaising with the General Surgeon, the GP and the pain management Consultant, the Medicess Doctor supported the multidisciplinary team with delivering treatment in consideration of the medical aspects of Mr. A’s presentation.

Extensive advice was provided with regard to the management of the colostomy within the workplace, guiding the return-to-work process.

Medicess Occupational Therapist

The Medicess Regional Occupational Therapist worked closely with the team, the employers and specifically the Medicess Employment Consultant, performing an early worksite assessment.

A robust and medically sound suitable duties programme was developed, implemented and progressed. This enabled a successful return to the pre-injury employer.

Medicess Employment Consultant

Liaison with the local Disability Employment was an essential component to success of the return-to-work. The knowledge and experience of the Employment Consultant allowed the provision of retention services to support the patient and employer enabling the return-to-work and access to funding.

Benefits of our Involvement

The Medicess team worked collaboratively to address the medical, psychological, physical and vocational needs. These aspects would have otherwise not been coordinated to achieve overall outcomes.

Working within their respective disciplines enabled the appropriate, timely and credible direction of the rehabilitation to expedite and coordinate services that would have normally been delayed, unavailable and uncoordinated. Without our involvement this would not have resulted in the optimised recovery and accelerated return-to-work that was achieved.