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Improving stroke services

Therapy assistants contribute to the successful development of a stroke unit.

Why was the initiative launched?
How was the work taken forward?
A role for therapy assistants
Filling new posts
What has been the impact of therapy assistants on the stroke unit?
The contribution of therapy assistants
What has been learnt about the employment of therapy assistants?
Looking to the future
Tips for Success
For more information contact
ImpAct bottom line

Why was the initiative launched?


Therapy and medical staff had highlighted the need for a stroke unit in Bradford Hospitals Trust for several years. Research evidence demonstrated the benefits of a coordinated approach. It was difficult providing effective rehabilitation for patients with stroke illness across some 15 wards on two sites. Many patients seemed to spend much of their day doing nothing. In 1997 the opportunity to make progress arose when senior managers agreed that the introduction of a Stroke Unit should be a top priority. This allowed management time to be devoted to the task, but the caveat was that it had to be achieved within existing resources.

How was the work taken forward?


Multi-disciplinary steering and operational groups were formed early in 1997 to develop and implement proposals. They were asked to work in a time frame of less than six months. The plan was to have the unit operational by October 1997. Jackie Hansford, a nurse manager at the Trust, led the work. Operational policy was developed in the light of research evidence with the aim of offering effective rehabilitation and improving lengths of stay through a coordinated approach.

A role for therapy assistants


Therapy assistants had been shown to improve patients' experience of rehabilitation and to shorten length of stay on the amputee unit in vascular elective orthopedic wards in the Trust (ImpAct May 1999: issue 1). A team of occupational therapy and physiotherapy managers led by Val Steele, Director of Rehabilitation, adapted the model to provide support staff to the qualified therapy team in the Stroke Unit. The assistants would be trained to deliver rehabilitation packages planned and monitored by the qualified therapists, including speech and language therapists. The team decided that the therapy assistants would not be trained in nursing duties to ensure that the emphasis on rehabilitation was maintained. Experience had shown that caring/nursing demands tended to detract from rehabilitative activities when there was pressures on wards.

A key appointment in the stroke unit was Mary Hudson as lead therapist. A senior sister was also appointed. The lead therapist has a key leadership role with the therapy team and the rest of the multi-disciplinary team in achieving and maintaining a rehabilitation ethos in the ward. The lead therapist, therapists and assistants are based on the ward.

Filling new posts


Because the development work had to be contained within existing resources additional funding for the new posts was not available. This meant that short-term appointments had to be made. There was some concern that recruitment of therapy assistants might be difficult because of the short-term nature of the posts and the salary scale. These fears were unfounded; in the event, there was a big response to local advertisements.

What has been the impact of therapy assistants on the stroke unit?


Six part-time assistants were appointed in 1997 (three wte), initially on six month contracts. The appointees had a range of backgrounds, including one person taking a gap year before starting medical training. Another two have completed the necessary A levels to allow them to be accepted onto a physiotherapy degree course.

From the start the therapy assistants worked weekdays with the therapists. Later as they achieved identified competency levels; they covered the seven-day week delivering therapy programmes planned by the qualified therapists to meet identified goals, reviewed weekly by the team. Support and training for the assistants is organised by the lead therapist. Following the success of the initiative recurrent funding for the posts is now secure.

The contribution of therapy assistants


There was some scepticism initially from other disciplines about the contribution the assistants could make, but this evaporated as the benefits began to be realised. The Stroke Unit team has introduced shared patient records, multi-disciplinary reviews and goal setting (with the patients) on a weekly basis and regular in-service training for the staff on the Unit. Assistants have been involved and appear to make an impact on the rehabilitation package, although this is difficult to quantify.

Over the first 18 months significant improvement was made to reduce the time taken to transfer patients to the Stroke Unit from other parts of the hospital (Figure 1). It is now being maintained at about two to three days. The length of stay in the Unit has stabilised at about 30 days. Overall performance continues to be well below the national target (57 days overall). Local audits have shown increased rehabilitative activity. The presence of the assistants has ensured that qualified therapists can focus their attention on complex work that cannot be undertaken by support staff.





The work in Bradford has shown that some of the national shortfall in qualified therapists can be overcome by the judicious use of well-trained and supervised therapy assistants. Working across professional boundaries they help ensure that patients receive an integrated rehabilitation package. The unit compared positively with other centres in a National Sentinel Stroke Audit. The Stroke Unit was commended by the Audit Commission as a centre of good practice in 'The way to go home: rehabilitation and remedial services for older people', Audit Commission, 2000.

What has been learnt about the employment of therapy assistants?


The Stroke Unit in Bradford has demonstrated that:

  1. Therapy assistants can be important channels of communication with patients and families. It is important that they have the opportunity to pass on the information to therapists and other members of the team, for example at the regular goal setting meetings.
  2. The views of patients and their families must be considered. Initially, the therapy assistants worked seven days a week for full days but patients made it clear that they did not want (and many could not cope with) early evening activity and they valued a quiet Sunday. The assistants now work from 8.15 am to 4.15 p.m.
  3. Other members of the team need training to understand the role of assistants and, indeed the role of therapists. Most new members of the multi-disciplinary team will not have experience of working with therapy assistants
  4. The assistants should help out nursing colleagues when the unit is unusually busy. Give and take ensures harmonious working, but the therapeutic role must be protected for the benefit of patients.
  5. There is a tendency for caring activities to predominate in busy ward areas, even if they have a rehabilitation role. A focus on therapeutic activity ensures that patients can benefit from consistent rehabilitation even when the unit is very busy and/or short of nursing staff.
  6. A revised approach for carers' groups may be needed. Therapy assistants provide a good point of contact with patients and carers and can be valuable as 'information providers'. Support for the Carers Group at Bradford started to dwindle because patients and carers were receiving adequate information.
  7. There are opportunities to use the posts as an entry into health related training. Most of those appointed initially have moved to other jobs in the NHS and have benefited from their experience. They are not highly paid posts and this probably impacts on the length of time that people stay. Nevertheless, the posts can provide a springboard to professional training.

Looking to the future


A pilot outreach service to support patients in the early transition stage after hospital in-patient discharge is being planned largely using experienced therapy assistants. It will be implemented subject to the availability of the necessary resource.

Tips for Success



For more information contact


Carol Rhodes
Occupational Therapy Manager
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:

Training programme for Therapy Assistants in Stroke Units


ImpAct bottom line

 

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