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Exploring the role of therapy assistants

Why was the initiative launched?
What was done?
Did it work?
Tips for success
To find out more contact

Improving amputee rehabilitation and exploring new roles in Bradford Hospitals

Why was the initiative launched?

Local service managers wanted to improve rehabilitation services for patients needing lower limb amputations. They decided to examine of ways of improving inter-disciplinary team working and to evaluate the potential improvement to care from having a therapy assistant. Two factors seemed to be delaying or preventing recovery: protracted in-patients stays and limited access to therapy activities. The management of lower limb amputees was being provided within a busy, acute vascular unit. But, perhaps inevitably, the needs of acutely ill patients took precedence over patients with less acute needs. A review of the literature pointed to the benefits of better team working. An earlier local initiative had demonstrated the benefits from increased therapeutic input to rehabilitation following elective orthopaedic surgery.

What was done?

The development of the job specification for ward-based therapy assistants was the first task. A detailed analysis, by senior local clinicians, of specific clinical tasks identified those that could be delegated to a competently trained, non-professional assistant. Subsequently, staff were recruited and trained activities in the physiotherapy, occupational therapy and nursing skills related to amputees.

The job specification (for therapy assistants) required that they be employed on a seven day week basis - recovery should not be put on hold at 5 o'clock on Fridays! It guaranteed a real increase in the amount of therapeutic activity undertaken by patients. A six-bedded intensive therapy bay in the acute vascular ward provided the working base for the therapy assistants. It was equipped for patients needing rehabilitation after amputation. Evidence suggested that keeping patients together the improved patients' morale and speeded their recovery.

Initiatives to improve inter-disciplinary team performance focused on improving communications between team members. Training ensured that the distinctive roles of individual team members were understood - in particular to ensure that other disciplines were clear about the role and contribution of therapy assistants. Weekly inter-disciplinary team meetings were organised to review the needs of individual patients: a social worker was key member of the team. Factors that might affect discharge were given particular attention.

Earlier patient surveys about the information they received about their operation and rehabilitation had recorded mixed views from patients about its quality. There was inadequate information about the reasons for amputations and about social security benefits. A series of semi-structured interviews with a group of patients (focus groups) helped guide the development of improved patient information material. This gives patients comprehensive and understandable information about rehabilitation.

Did it work?

The work has confirmed that the employment of therapy assistants can speed the rehabilitation and earlier discharge of patients following lower limb amputation. Evaluation of the initiative - using comparative information from the previous year - has shown that:

Effect of ward-based therapy assistants in lower limb amputation
Outcome Before the new service After the new service
Admission to discharge (days) 43.4 25.5
Number of patients surveyed 47 21
Rehabilitation activities observed (percent of time) 4.7 38.9
Number of patients surveyed 12 5

Tips for success

√ Therapy assistants - non-qualified staff trained to provide a limited range of clinical interventions - can be effective and may have relevance in other clinical settings.
√ Experience has shown that it was not practical to include nursing responsibilities within the job description for therapy assistants - it placed difficult pressures on staff - being 'torn between care for patients requiring acute care and rehabilitation'.
√ Good communications are one of the keys to good interdisciplinary work. Ensure that role boundaries are clear.
√ Handle communications with patients carefully - encourage all members of the team to keep within the care plan for the patient agreed by the team - avoid 'ad hoc' comments - for example about likely discharge dates.
√ Patients and carers can provide valuable contributions to service developments.

To find out more contact

Val Steele, Director of Rehabilitation, Bradford Hospitals NHS Trust St Luke's Hospital, Little Horton Lane, Bradford BD5 0NA. Telephone 01274 365275; Fax 01274 365326

The following material is available:

• Job description
• Competency manual
• Patient information

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