Not enough info

While on placement in the community setting, my supervisor and I encountered a patient who had been referred to physiotherapy upon discharge from hospital. She had been admitted to hospital following a fall caused by her legs shaking and then giving way. No cause was discovered however her referral only stated the diagnosis as “leg weakness”. As her medical notes took a few days to come to our office we were not able to access the investigations carried out. On assessment the patient’s the patient had good muscle strength, however experienced fairly severe shaking when quads were activated against manual resistance or on sit to stand. This was relieved through activation of hamstrings or marching on the spot. Her muscle tone was normal. My supervisor and I queried anxiety or some underlying neurological problem as the cause, however the cause needed to be investigated. This patient was later readmitted to hospital for further investigations. I believe the cause of the shaking legs should have been investigated further in hospital, or information given in the referral as to the outcomes from investigations carried out.

This incident highlighted these issues
1) The need for a thorough assessment to be carried out prior to referral and adequate information should be included in referrals to other physiotherapists.
2) If inadequate information is contained in a referral I should always attempt to call the referring source for a verbal handover.
3) The need to fully investigate abnormal findings and refer onwards is vitally important in the community setting as you may be the only health professional that they speak to about a certain problem.


IN THE FUTURE, PRIOR TO REFERRAL TO ANOTHER PHYSIOTHERAPY SERVICE, I WILL ALWAYS ASSESS A PATIENT ADEQUATELY AND ENSURE MY HANDOVER INVLOVES SUFFICIENT INFORMATION FOR THE NEXT PHYSIO. I WILL ALSO MAKE SURE I CLARIFY ISSUES OR ABNORMAL FINDINGS AND DISCUSS THESE WITH A SENIOR OR REFER ONTO ANOTHER HEALTH PROFESSIONAL IF NECESSARY.