Purpose
The modern NHS endorses 7 day service provision.
The BRSM standards for neurorehabiliation state provision of transitional services are required additional to inpatient rehabilitation. Financial constraints, pre-existing staffing shortfall, small patient cohorts and inclusion of patient weekend home leave limit the feasibility of services being able to provide these.
Southampton Children´s Hospital received funding (2015) to meet the BRSM standings of staffing for 4 neurorehabilitation beds. The physiotherapy team then instigated the first national paediatric neurorehabilitation service working in a modified capacity across 7 days.
Undertaken by shift swaps within the working week, incorporating 4.2WTE qualified Physiotherapists and 2.7 WTE therapy technicians from within the wider therapy service. A limited criteria lead transition service was established at the same time.
Approach
To review the impact of the modified rehabilitation pathway regarding:
- Instigation of a modified service at weekends/bank holidays on enhancing patient pathway.
- Patient/family perception of benefit.
- Impact on staffing to enable weekend shifts had on weekday service.
- Ability to consistently provide a 7 day service with a small staffing cohort.
- Need and impact of providing a transition service within the rehab pathway.
Data extrapolated from a secure database regarding patients receiving rehabilitation at weekends/BH and those accessing transition service between September 2015 and December 2018. Work force data identified from hospital rostering system and incident forms. Parental perception gained from optional discharge questionnaires instated in 2016.
Outcomes
359 days of supplementary rehabilitation provided, equating to 855 individual sessions for 132 patients (n=66 boys, age range 0.3-17.9 years, 43 neuro/neurosurgical, 89 neurorehabiltation).
46 new patient referrals started their rehab pathway 1-4 days earlier than standard service.
7 patients discharged from therapy (post op neurosurgical) over a weekend/BH. Caseload numbers for weekends variable of 3-4 per day (range 0-7). 70% of patients had weekend leave during their rehabilitation journey.
32 discharge questionnaires completed. 87% accessed weekend services with mean perception of benefit 4.6/5 (0-5 grading scale).
Staffing availability limited full service provision both at weekends and during the weekday. 24% of weekends had reduced provision and an additional 4% no cover. 43% of shift swap days did not have appropriate staffing levels to meet service needs.
18 patients accessed transition with a mean session attendance of 3.5 (range 1-9). 39% accessed transition whilst awaiting community services uptake and 39% as they did not meet community criteria.
Geographical distribution demonstrated need for patients to travel between 0.4-72.7 miles to access the service.
A modified 7 day physiotherapy neurorehabilitation service provides effective supplementary rehabilitation beneficial to the patients, yet due to staffing it can negatively impact on the rehab provision during the week. Gaps within community therapy services can create the additional need for a transition service but puts additional pressure on the acute rehabilitation services to deliver this supplementary care.
Implications
Accurate identification and funding of increased staffing numbers are required to provide a consistent and sustainable 7 day provision, including identify a method to calculate impact on length of stay to enable cost benefit analysis.
Funding acknowledgements
N/A.
Additional notes
This work was presented at Physiotherapy UK 2019 |