How are you meeting the NICE Quality Standards on 45 Minutes of Therapy and Seven Day Working? A South Devon Perspective Kathryn Bamforth Clinical Specialist Physiotherapist Newton Abbot Hospital Torbay and Southern Devon Care Trust

NICE Quality Standard No. 7 (2010) Patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it. Torbay and Southern Devon Care Trust Patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.

The 45 minute debate Why 45 minutes? – Dose : response effect in motor rehabilitation (Kwakkel et al, 2004; RCP Guidelines for Stroke – Physiotherapy, 2008) – Intensity of required SLT input remains unclear (Cochrane review, 2010) What is the ideal dose?? Why would you not receive 45 minutes of therapy? Torbay and Southern Devon Care Trust

Optimising Practice Opportunity Restructured PT and OT staffing levels Created 3 Band III Rehabilitation Support Workers working flexibly to include Sat & Sun Included qualified staff from the ward and community team on a weekend rota to work Saturday mornings (1:12) Torbay and Southern Devon Care Trust

Data Collection National Project – Admission to assessment time – LOS – Discharge destination – Patient, carer and staff satisfaction Torbay and Southern Devon Care Trust

Results Admission to assessment time – 2008: 80% within 24 hours – 2010: 100% within 24 hours LOS – 2008: 21 days – 2010: 19 days Discharge destination: No change Torbay and Southern Devon Care Trust

Patient Satisfaction In your opinion, were there enough therapists on duty to care for you in hospital? Torbay and Southern Devon Care Trust Always or nearly always 77%47% Sometimes23%33% Rarely or never0%20%

Satisfaction (Cont’d…) Carer: Appreciated weekend service particularly access to physiotherapy Staff: Increased confidence to progress treatment plans in a more timely fashion Friday discharges 100% agreement to continue current service Torbay and Southern Devon Care Trust

Local work Capacity and Demand exercise – “units” of 45 minutes – Time and motion study of therapists’ time Torbay and Southern Devon Care Trust

Next Steps Complete Capacity and Demand exercise – efficiency across the week Group work Extend RSW role to offer SLT support Repeat audit process Torbay and Southern Devon Care Trust

Conclusion 45 minutes more of a guideline than a prescription? Therapy is highly individual Patient-led rather than service-led Challenge to services: to be able to offer each patient what is needed. Torbay and Southern Devon Care Trust

“I’m such a good lover because I practice on my own” Woody Allen “Everything is practice” Pele Torbay and Southern Devon Care Trust