067 Improving access to same-day initial therapy assessment with later working patterns

Published Date: 21st November 2016

Publication Authors: Hill AM

Introduction
Early initial multi-disciplinary therapy assessment following stroke admission is important to establish baseline function, engage patients and families, manage expectations and set realistic rehabilitation and treatment goals. Bray et al established that there are significant variations in assessment time according to time of admission and day of admission. We established that working practices common across the United Kingdom do not align with peak times for patient admission, and that many patients were receiving initial therapy assessments the following working day after their admission with stroke.

Method
Our service consists of a 7-day physiotherapy and occupational therapy service, and 5-day speech and language therapy service. Pre-intervention, all therapists worked between 8 am and 4 pm. Patients are reviewed upon arrival to the Hyper-acute Stroke Unit by the team. We trialled adjusting therapy working hours: a single therapist from each discipline started work later and was available until 7 pm each day on weekdays. This was also beneficial for some members of the team as it allowed additional flexibility for childcare. As an adjustment of working hours this was cost-neutral. Data was collected for the Stroke Sentinel National Audit on initial review times per normal routine. Retrospective analysis of data occurred for 9 months prior to introduction of the service, and 9 months subsequently.

Results
Median admission-therapy assessment times for physiotherapy, occupational therapy and speech and language therapy were established at 4-hourly intervals for each day of the week in both the pre-intervention and post-intervention cohorts. The majority of stroke admissions occur between 8 am and 4 pm. At our Trust the median arrival-HASU admission time is 2 hrs 15 minutes. The post-intervention cohort saw significantly improved therapy assessment times particularly in those patients arriving between 8 am and midday. Because these constituted a large portion of the overall stroke population, overall median assessment times fell sharply. Patients in the midday – 4pm admission of the post-intervention cohort were still often seen the following day: this demonstrates that either improving the speed of access to the ward, or extending working hours further would give more patients same-day initial therapy assessment.

Conclusion
Afternoon and late shift working hours for therapy teams are a cost-neutral and effective way to offer same-day initial therapy assessments to large portions of the stroke population and reduce inequality in stroke admissions. They can also be beneficial for the work-life balance of individual members of the therapy team. This is dependent upon an efficient and consistent admission process for suspected strokes.

Talbot, L; Connor, C and Hill, A. (2016). 067 Improving access to same-day initial therapy assessment with later working patterns. International Journal of Stroker. 11 (Suppl 4), 39

 

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