Evaluating the impact of Therapy Support Workers on Provision of Rehabilitation in Adult Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation

Purpose

The purpose of this project was to explore the use of Therapy Support Worker roles in enhancing rehabilitation provision for critically ill adult patients within Intensive Care, in terms of patient outcomes, service performance indicators, and patient experience.

£220,357
potential net saving, per annum based on anticipated VVECMO activity

Approach

Outcomes were compared for patients receiving physiotherapy rehabilitation versus a matched-comparison group receiving usual care prior to the introduction of the Therapy Support Workers. Patients were included if they were admitted to ICU and discharged alive between 1st October 2017 and 30th September 2018 (intervention), and between 1st April 2016 and 31st March 2017 (usual care). Mortality and APACHE II scores were compared, and serious adverse events recorded. Rehabilitation included active or active-assisted bed exercises, cycle ergometry, edge of bed sitting, transfer to chair, and mobilisation, and was measured using the ICU Mobility Scale (IMS) and Chelsea Physical Assessment Tool on ICU discharge. In addition. Usual care consisted of passive movements and airway clearance by a qualified Physiotherapist. A locally designed questionnaire was used to collect patient experience data. Ethical approval was not required for this project.

Outcomes

Results: There was no significant difference in total ICU LoS (median 13.5 vs 13, range 52 vs 48, p=0.649), ICU Mobility Scale score (median 4 vs 5, range 10 vs 8, p=0.087) or CPAx score (median 21 vs 26, range 42 vs 39, p=0.060). However, more patients mobilised independently without a gait aid (20% vs 2.8%) and all patients were at least passively moved to a chair (100% vs 72.2%) before ICU discharge. There was a significant difference in patient satisfaction scores (median 36.5 vs 45, range 19 vs 13, p= 0.004). There was no statistically significant difference in APACHE II scores or mortality and no adverse events were recorded.

Conclusion(s): This evaluation suggests that rehabilitation provided by Therapy Support Workers during VVECMO may be beneficial for length of stay and functional outcomes, however this improvement was not statistically significant. Further exploration of the timing of interventions at different stages of illness may provide more robust analysis of the impact of rehabilitation. Patient experience data showed a statistically significant improvement following the addition of Therapy Support Worker rehabilitation, which would benefit from more detailed qualitative data in future work.

Cost and savings

Potential net saving of £220,357 per annum based on anticipated VVECMO activity.

Implications

The data from this evaluation demonstrates that Support Worker rehabilitation in critically ill adult patients receiving VVECMO is safe, and may provide a high quality, cost-effective alternative to qualified physiotherapy staff with the application of appropriate clinical governance.

Top three learning points

No further information. 

Funding acknowledgements

This work was funded by NHS England as a successful bid for Marginal Rate Emergency Tariff (MRET) for specialised services.