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Date submitted 5th June 2017
Site St John’s Hospital – NHS Lothian Contact Details Megan Reid – Service Improvement Manager
[email protected] Title of case study Piloting a 5/7 day working model of AHPs 6EA (choose one, see AED)
EA5: 7 Day Services
Please describe the project in 250 WordsBackground
A local objective was to explore the possibility, practicalities and impact of delivering a 5 over 7 days working model of physiotherapists (PT) and occupational therapists (OT).
The objective aligns to the following key drivers:- AHP national Delivery Plan - NHS Lothian Corporate Objectives- National targets including 4 hour emergency access standard and SIGN guidance
It also aligns to the following essential actions of unscheduled care:- EA 3: Patient rather than bed management - EA 4: Medical and surgical processes aligned - EA 5: 7 Day Services
Aim/ Anticipated Benefit [Description of anticipated benefit]
To increase targeted seven day physiotherapy (PT) and occupational therapy (OT) input to in-patient adult physical services.
To improve the quality of care through more rapid AHP assessment.
Implementation & Approach [Improvement & Engagement approaches used]
A programme board with Pan-Lothian representation was established following previous investigatory work. Membership included AHP managers, finance, HR and partnership among others.
The programme Board identified OT and PT adult physical services to be the focus of a phase one pilot. Funding was secured to substantiate the weekend rosters and uplift weekend cover.
A member of the AHP team was named as project lead to implement and review the pilot.
The table below illustrates the difference in weekend cover pre and post implementation of the pilot.
Case Study Submission
An increase in weekend cover for both PT and OT was tested. Both PT and OT teams developed criteria to support triaging of patients, both new and existing inpatients known to the service, to allow prioritisation of clinical time.
Pre 5/7 Working Post 5/7 WorkingPT – Respiratory 1 PT working up to 7.5
hours/day1 PT working 7.5 hours/day
PT – Medical/Roving No PT cover 1 PT working 7.5 hours/dayOT– ED, Observation Ward, Medical/Roving
1 OT working 4 hours/day 1 OT and 1 OT support worker working 7.5 hours/day
Outcome [Outcomes and evidence of impact of improvement on 6EAs, overall 4 hour performance or specific flow group(s)]
In summary:
- Increase in number of new patients seen by PT and OT at weekend- Increase in number of second and subsequent contacts made by PT and OT at
weekends- Reduced mean days from admission to ‘therapy ready to go’- Positive patient experience feedback - Positive staff experience feedback
Please see appendix for detailed measurement outcomes.
Key Lessons Learned
The impact of introducing / increasing weekend cover on weekday working should be monitored and included in any review.
Introducing cover into areas that previously did not have any eg. PT in MAU requires staff to be familiarised with the area, ways of working and may identify training needs for staff to feel competent in a range of clinical areas within the hospital.
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Appendix 1 – Detailed Measurement Outcomes
Number of contacts - all
The following table illustrates the impact of the pilot on weekend working activity of both PT and OT. Data recorded over a 3 month period.
New Patients Seen
Second/Subsequent Contacts
PT
% difference post 5/7
86 patients
+538%
89 contacts
+43%
OT
% difference post 5/7
8 patients
+ 19%
88 contacts
+44%
Number of contacts - PT in medicine
The pilot increased the PT in medical/roving from no weekend cover to 1 PT working 7.5 hours/day. The response time from PT within medicine was measured – results below.
Total number of new patients seen by PT in
MAU
Total number of second/subsequent contacts in MAU
Total number of second/subsequent
contacts in acute medicine
Pre 5/7 Working 0 6 0Post 5/7 Working
82 8 81
LOS and Time to ‘therapy ready to go’
It was acknowledged that a range of complex factors facilitate a discharge therefore the time from admission to when a patient was ‘therapy ready to go’ was measured along with LOS – results below.
Pre 5/7 Working Post 5/7 WorkingMean LOS 17.2 days 12.3 daysMean days to therapy ready to go
11.6 days 9.2 days
Patient Experience
Responses post 5/7 workingCommunication from therapy staff 88% satisfied or very satisfiedOverall care from therapy staff 100% satisfied or very
satisfiedAmount of therapy input received on weekdays 100% felt this was ‘about right’Amount of therapy input received on weekends 100% felt this was ‘about right’
Staff Experience – regarding 5/7 PT service
- 78% of respondents were aware of new 5/7 service prior to completing survey
- 78% of respondents (including 100% medical staff) who had involvement with the service noted that the pilot working added value to their clinical area at the weekend.
- 83% of respondents (including 100% medical staff) felt service had beneficial impact on patient flow, reduced length of stay and increased weekend discharging.
Staff Experience – regarding 5/7 OT service
- 87% of respondents were aware of new 5/7 service prior to completing survey
- 90% of respondents (including 100% medical staff) who had involvement with the service noted that the pilot working added value to their clinical area at the weekend.
- 87.5% of respondents (including 100% medical staff) felt service had beneficial impact on patient flow, reduced length of stay and increased weekend discharging.
6 Essential Actions - Action Effect Diagram
