Physiotherapy workforce innovation

Leeds Teaching Hospitals NHS Trust’s stroke rehabilitation (rehab) ward employed three allied health professionals (AHPs).

As part of its nursing workforce, the AHPs improve patient care and rehab culture. They make it easier for all staff to engage patients in their own rehab for as much of the day and night as possible.

The role of these AHPs is to:

• work alongside registered and unregistered nurses to support ward-based personal care and daily living activities
• support competency-based training of clinical support workers to maximise therapeutic opportunity in everyday tasks
• make sure patients progress along their rehab pathway safely and efficiently - all members of the multidisciplinary team on all shifts are involved, leading to quicker achievement of patients’ goals and therefore quicker discharge home

The stroke rehab ward had several nurse vacancies. There was some frustration from all staff on the ward. They felt patients were getting only their basic care needs met. Health care assistants wanted to extend their role. Therapy sessions were being delayed because patients weren’t ready for therapy. This led to some friction between professions at times.

The leaders on the ward recognised a possible solution. AHPs were able to contribute to patient safety and quality of care. They supported the development of the workforce to improve the ability of the whole team to deliver holistic care and rehab as one unit.

Achievements

Introducing ward-based therapy staff integral to the nursing teams has significantly influenced the culture and ability to deliver quality care in a rehab setting.

The whole team reports improved understanding of each other’s roles and pressures. Staff identified areas of crossover where they can work more collaboratively and effectively.

Health care assistants report improved job satisfaction. They can be more holistic and support patients to be more independent because they have more time and have had training. Because of this, therapists report improved ability to progress patient’s functional ability. This has improved their rate of progress.

Patients are becoming more active on the ward. They take responsibility for their own goals and some of their treatment. They have support around the clock to engage in appropriate rehab. Patients are ready for specific therapy sessions on time and have a structured rest time in the afternoon. The whole unit is more efficient.

Next steps

Because of the success on this rehab ward, the approach has been trialed in the acute neurosurgical clinical area. That team now takes on more duties that were historically done by nurses. The team takes care of functional washing, dressing and toileting as part of therapy treatment. They can now spend more time making sure patients are in safe positions.

Ongoing work will support patients with tracheostomies. This is an area of high demand for nursing staff. Physiotherapists are particularly skilled in this area and can support nursing staff. This reduces some of their workload and improves the process of step down from critical care.