Identifying the Physiotherapy and Occupational therapy service provision for patients admitted with neurological conditions- are we coordinating care?

Purpose

During an acute admission early assessment and treatment provided by the Multi-Disciplinary Team (MDT) is a requirement of the National service frame work for long term conditions.

Within our large London teaching hospital, we were aware that patients admitted who had a long term neurological condition, other than stroke, were not being treated with an integrated MDT approach.

We were concerned that patients' needs weren't being best met in a timely way, joint goal setting was not happening and discharge planning might not be optimised. However, we had limited data to support these observations as patients were dispersed throughout the hospital.

Approach

Retrospective data collection of all patients referred by a ward therapist to either the neurological occupational therapy (neuro-OT) or physiotherapy (neuro-PT) services between March 2017 to April 2018.

We carried out a service evaluation, reviewing patient demographics and the service they were receiving.

Outcomes

During this period 162 patients were referred to neuro-PT/OT, of which only 32 (19.6%) were referred to both OT and PT. Median length of stay was 31 days with 61% of the cohort being discharged home.

Patients were located in nine directorates throughout the hospital with the majority (44%) under acute medicine. Patients have to be referred by ward therapists to initiate either neuro-OT or PT seeing the patient. Median time from admission to initial neuro-OT assessment was 11 days but patients were seen sooner by neuro-PT, a median of 8 days.

Neuro-OT had a wide range (0-20 days) between referral and assessment, due to the existing prioritisation system. 9 referred patients were not seen by neuro-OT as they were repatriated or discharged before this occurred. In contrast, all patients referred to neuro-PT were seen within a range of 0-4 days. Any coordinated working between PT and OT was ad hoc due to initiation by the individual therapists but there was no systematic format for either therapy or wider MDT care coordination or goal setting.
 

This patient group has a long LOS and are likely to have complex needs but the majority return home so need coordinated discharge planning. We have identified differences in OT/PT service provision and responsiveness to referrals.

Better sharing of information once patients are identified could help more timely and coordinated care. We have initiated a neuro-OT/PT patient discussion meeting asking 5 key questions- does the patient require MDT input, does the discussion initiate referrals to other disciplines, what are the patient's goals, what are the therapy plans for onward care, and are there any challenges for care identified for the patient?

Implications

Using no additional resources does this joint neuro-OT/PT discussion result in any improvements in care coordination and ultimately efficiencies in the service. This patient discussion session will require further evaluation.

Funding acknowledgements

None.

Additional notes

This work was presented at Physiotherapy UK 2019