Evaluation of the Older Adults Specialist Intervention Service Christina Richards Clinical Services Manager and Head of Therapies

Background Traditional ways of working for occupational therapy and physiotherapy was being challenged. As a result of this following consultation with occupational therapists and physiotherapists it was decided to trial ‘front loading’ therapy services

Working with Brunel University Need for evaluation for the service Challenges of data collection A quantitative and a qualitative study were agreed

Aims To determine the impact of service re-design on:  length of stay  face to face therapy time  non-face to face therapy time  Re-admissions The aim of the qualitative study was to ascertain therapists’ perceptions of the changes on current and previous roles and professional practice.

Methodology 1.Secondary data analysis on quantitative variables Participants: 332 patients seen by the older adult therapy team before & after the service re-design. ANCOVA was used to compare the 2 groups in LOS & face to face therapists’ time Chi-square was used to compare the 2 groups in number of re-admissions T-test to compare the 2 groups in non-face to face time Confounding variables: age, gender, diagnosis & CCG involved

Methodology Semi-structured Interviews (3 OTs and 3 PTs) The interview data schedule consisted of questions regarding the therapists’ work experience, their perceptions of the changes that occurred, the strengths and negatives of the change process from both a clinical and professional perspective. Template Analysis was used to analyse the data

Results LOS (covariates: CCG & gender)  Statistically significant reduction (p<0.001)  Reduced by 9 days  Savings: £2025 per admission (£225 / overnight stay)  363 admissions over 5 months (Aug – Dec ‘12: £735,075 savings  £1,764,180 per year Face to face time (covariates: age)  Statistically significant reduction (p = 0.002)  Reduction by 45 min per patient

Results Non face to face time Non-statistically significant increase (p= 0.73) Readmissions  Non-statistically significant 4.3% increase (p = 0.68)

Results Impact on Therapists: Following the redesign some therapists reported positive benefits relating to patients having more therapy and they perceived themselves as feeling less stressed. Although there was a view by some therapists that prior to the new ways of working there was more of a focus on rehabilitation and a feeling their role was too generic. Shared Tasks: Therapists were willing to share roles related to mobility/transfers and social information gathering. Patient/Therapist Relationship: Therapists perceived many benefits for patients and families which were associated with continuity of care. Impact on MDT Working: Some therapists were no longer able to attend ward meetings following the redesign as these were no longer ward based.

Interpretation of Results Successful changes in improving productivity without compromising quality of care Role integration is perceived as having positive impact on person centred care and professional development of therapists. The integrated approach to therapy practices did not appear to have a direct impact on reducing professional pressures. However these were no different prior to the changes

Interpretation of results Reasons for significant reduction in length of stay Face to face vs non- face to face time Re-admissions – role of community services in supporting patients to prevent re-admissions

Successes following implementation Continued ‘front load’ therapies Increased awareness within the organisation of the benefits of therapy intervention in terms of patient outcomes. Generic working has continued and is being further developed.

Challenges following implementation Therapy staff and the wider MDT found it challenging in terms of no longer being ward based. Ensuring that therapy plans are continued by the wider MDT. Recruitment and retention of staff

Next Steps To implement therapy services within ED To work across the whole system to reduce re- admissions and the important role of AHPs within this. To continue to promote the role AHPs have in terms of improving patient outcomes across the whole patient pathways To seek ways of continuing to add to the evidence base for AHPs.

Acknowledgements Dr Anita Atwal Dr Georgia Spiliotopoulou Occupational Therapy and Physiotherapy Staff at WMUH

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