Guy's and St Thomas’ NHS Foundation Trust

Clinical challenge
To increase access to and quality of therapy provided at an acute rehabilitation stroke unit. In 2014/15 the unit did not achieve 45 minutes daily occupational therapy (OT) and only half of patients were accessing occupational therapy.

Solution
Maximised use of resources

• Developed an assessment tool for families to complete home assessments themselves to reduce the need for occupational therapists to travel to patients' homes, and thereby increase therapy time delivered to patients as a result;
• Divided up therapy time during the day to incorporate 45 minute therapy target for those individuals who may not be able to tolerate a single session;
• Embedded daily rehabilitation timetabling across the whole in-patient pathway embedded within ‘team timetabling’. This ensured capacity and priorities were managed across whole team.

Organisational change

• Piloted a research project to demonstrate feasibility of home environment assessment using information technology (iPads);
• Prioritised new admissions within 24 hours to establish rehabilitation plans and increase the number of days which patents are treated by OT;
• Developed creative group therapy sessions to ensure daily intensive rehabilitation through “Brunch and Lunch” groups thereby ensuring therapeutic and social interactive benefits.

Improved team working

• Collaborative joint working between social services and OT resulting in a seamless referral process avoiding bureaucratic processes;
• Monthly ‘working group’ led by OT, ensuring service delivery and quality improvement projects are highlighted, prioritised and enacted.

Impact
The stroke unit at St Thomas’ has consistently achieved a SSNAP score of A for OT since these changes have been made. The project also provided a blue print template for the Trust to have achieved an overall SSNAP score of A consistently across 2015-17 (one of very few A scoring stand-alone non HASU stroke services in London). The hospital has achieved the lowest quartile median length of stay in London. There are approximately 1% referral rates to tertiary neuro-rehabilittaion inpatient beds due to efficiency working between inpatient and stroke community services lead by OT.