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

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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. References
Department of Health (2015) Making healthcare more human-centred and not system-centred. (Online). Available from: (Accessed 2 August 2015).
NHS England (2013) Everyone counts: planning for patients (Online). Available from: (Accessed 2 August 2015).
NHS Improving Quality (2013) NHS services, open seven days a week: everyday counts. (Online). Available from: (Accessed 2 August 2015).
NICE (2008) Delirium: diagnosis, prevention and management. (Online). Available from: (Accessed 2 August 2015).

13. References
NICE (2012) Patient experience in adult NHS services. (Online). Available from: (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: (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
The Kings Fund (2012) Continuity of care for older hospital patients: a call for action. (Online). Available from: (Accessed 2 August 2015).

14. Contact