Guy's and St Thomas' NHS Foundation Trust

Clinical challenge
In 2016 the average length of stay on the Acute Stroke Unit (ASU) was 32 days and Occupational therapy and Physiotherapy provided a 5-day therapy service only.

Solution
The Seven Steps to Measurement for Improvement Model was used to guide the change from a 5‐day to 7‐day therapy service.

Data were collected 6 months pre- implementation and then post-implementation using SSNAP report data including:

• Median therapy length of stay.
• Median hospital length of stay.
• Median % of days as an inpatient on which therapy is received.
• Median time from admission to first therapy assessment.
• Patient and carer feedback: A structured questionnaire was used to obtain patient and carer feedback.
• Number of therapy sessions per week.

Impact
Physiotherapy

• Reductions in physiotherapy median length of stay (24.8 to 17.4 days).
• Median hospital length of stay: Reduction of total hospital length of stay (32 to 23.4 days).
• Median % of days as an inpatient on which therapy is received increased from 73.9% to 99.5% on SSNAP
• Time from admission to first therapy assessment increased from 77% to 96%.
• Patient and carer feedback: Patients and carers preferred the 7-day service.

Occupational therapy​
In response to the positive results of the physiotherapy service, in July 2019 a seven-day Occupational therapy business case was approved including an uplift of staffing of 1.5 WTE OT and rostering one OT to work on a Saturday and Sunday. Building on the measures used for the Physiotherapy pre and post implementation data is being completed with the following additional measures:

• Frequency of different days of the week in which discharges occur.
• Number of access visits completed at weekends and carer satisfaction.

6-month data will be analysed January 2020

Reflection
Whilst 7-day therapy can improve therapy intensity and reduce length if stay on an ASU, this is only possible with an adequately staffed service. Careful consideration has also needed to be taken to ensure there is high quality handover of patient care and where possible consistency of therapist treating patients.