Therapy Timetabling, an evaluation of outcomes following implementation at the Oxfordshire Stroke Rehabilitation Unit.

Purpose

The Oxfordshire Stroke Rehabilitation Unit (OSRU) provides short term inpatient rehabilitation for patients following acute stroke.

Intensive rehabilitative interventions improve functional outcomes (Barrett et al, 2018) but despite this, patients are often described to be 'inactive and alone' in hospital (Bernhardt et al, 2004).

Historically OSRU struggled to achieve the recommended 45 minutes per therapy, five days a week, as described in the National Clinical Guideline (RCP, 2016).

The ReAcT study (Clarke et al, 2018) reported positive effects of therapy timetabling on patient engagement, caseload prioritisation and minutes' therapy provided.

Occupational Therapy (OT) and Physiotherapy
maintained median session times of 45 minutes
% of days on which OT received
during admission increased from 44.6% average to 66.2%
% of days on which Physiotherapy received
during admission increased from 56.4% average to 70%
Average change on the Barthel score
increased from 4.01 to 5.06

Approach

A multi-disciplinary timetabling format was developed by the OSRU therapy teams, and a weekly timetabling meeting was instigated.

A standard operating procedure for the process was written and circulated amongst staff, with additional 1:1 training provided as required.

Weekly timetabling was implemented from the beginning of June 2018.

Five months pre and post data was analysed to evaluate the impact on therapy delivery and patient outcomes.

Outcomes

Preliminary data demonstrated:

  • Occupational Therapy (OT) and Physiotherapy maintained median session times of 45 minutes
  • % of days on which OT received during admission increased from 44.6% average to 66.2%
  • % of days on which Physiotherapy received during admission increased from 56.4% average to 70%
  • Average change on the Barthel score increased from 4.01 to 5.06

 

Initial findings support the observations from ReAcT (Clarke et al, 2018) and demonstrate the positive impact of weekly timetabling on team performance, therapy delivery, and potentially patient outcomes. Both OT and Physiotherapy increased the percentage of days on which patients received therapy, and maintained median length of sessions at 45 minutes.

Implications

It is hoped these findings will generate discussion and inspire other similar units to consider timetabling.

Funding acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019 and at  RCOT Conference 2019.