Seven day working: evaluating the impact of extending occupational therapy services for older adults in the acute setting

Session outline Why seven day working is important Service evaluation findings Quantitative Qualitative Transitioning to a seven day service

Introduction Three inpatient wards, eighty beds 65 years and over Complex discharge needs Range of co-morbidities 7 day working from November 2014 18 month service evaluation

Why should OTs work seven days? Key element of government’s five year strategy for the NHS (DOH, 2015) Seven day working should be whole MDT (NHS England, 2013; NHS Improving Quality, 2013; NICE, 2012) Poorer outcomes for older adult inpatients (NICE, 2008; The Kings Fund, 2012) Emergency Assessment unit: increase in assessments and discharges (Robinson et al, 2014). Supported by the College (RCOT, 2015) COT: Timely assessment Continuity of care Increase patients seen Maintain progress Reduce length of stay

Service evaluation Effectiveness measured by: Length of stay Weekend discharges Number of therapy contacts When therapy contacts carried out Time until initial assessment – 24 hour target Staff perceptions Total of 1851 patients Quantitative data (EPR TUTs): Length of stay, admission to HAU to discharge Discharge days of the week Total therapy time, direct and indirect contacts Day of the week of therapy contacts Number of days until initial assessment Qualitative data: Self-completed questionnaire Piloted first and amended

Quantitative outcomes Length of stay decreased 2.35 days No impact on day of discharge

Quantitative outcomes 45.31% increase in therapy contact A large number of patients (over 25%) are admitted to the unit on weekends, and seven day working allows these patients to be quickly assessed whereas previously they would have had to wait up to 72 hours, delaying discharge planning and increasing the risk of deterioration in function. 60 – 84% assessed within 24 hours

Qualitative outcomes Quality of care Occupational therapists highlighted: Lack of resources Challenges with handovers Impact on therapists Improved quality of care Lack of resources Staffing issues Other services not operating seven day service Access visit difficulties Challenges with handovers Difference with prioritisation Time to write handovers Too many patients on weekend list Impact on therapists Increased opportunities for development Less Monday and Friday stress Increase in income Days off during week Impact on personal life Quality of care Increased therapy contacts Patients progress faster Less risk of functional decline Reduction in length of stay Continuity of care Spend more time with patients at weekends Not all patients engage Easier to link with families

Qualitative outcomes Improved patient care Effect on MDT working The multidisciplinary team highlighted: Improved patient care Effect on MDT working Lack of resources Improved patient care Therapists should work at weekends Patients are more engaged Therapists can link with families Quicker discharges Continuity of care Effect on MDT working Help patients mobilise and sit out Clearer information on Mondays Negative impact on therapists’ days off Lack of resources Staffing levels Increase pressure on therapists

Transitioning services Meet with staff to help plan the changes Involve staff in planning rota Skill mix at weekends Ensure clear prioritisation system Evaluate outcomes

Key learning points Reduce length of stay Increase therapy time Reduce wait for OT assessment Increase engagement Improve joint working Needs to be carefully planned

References Department of Health (2015) Making healthcare more human-centred and not system-centred. (Online). Available from: https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred (Accessed 2 August 2015).   NHS England (2013) Everyone counts: planning for patients 2013-14. (Online). Available from: http://www.england.nhs.uk/everyonecounts/ (Accessed 2 August 2015). NHS Improving Quality (2013) NHS services, open seven days a week: everyday counts. (Online). Available from: http://www.nhsiq.nhs.uk/media/2416738/every_day_counts.pdf (Accessed 2 August 2015). NICE (2008) Delirium: diagnosis, prevention and management. (Online). Available from: http://www.nice.org.uk/guidance/cg103 (Accessed 2 August 2015).

References NICE (2012) Patient experience in adult NHS services. (Online). Available from: https://www.nice.org.uk/guidance/qs15/chapter/Introduction-and-overview (Accessed 2 August 2015).   RCOT (2015) Position statement: seven day services; the added value of occuapational therapy in health and social care. (Online). Available from: https://www.cot.co.uk/sites/default/files/position_statements/public/Seven-day-services.pdf (Accessed 2 August 2015). Robinson, A., Lord-Vince, H. and Williams, R. (2014) The need for a 7-day therapy service on an emergency assessment unit, British Journal of Occupational Therapy, 77 (1) pp.19-23. The Kings Fund (2012) Continuity of care for older hospital patients: a call for action. (Online). Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/continuity-of-care-for-older-hospital-patients-mar-2012.pdf (Accessed 2 August 2015).

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