Reporting of therapy intensity

2016 NICE Quality Standard Statement 2

Patients with stroke are offered a minimum of 45 minutes per day of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.

 

SSNAP has calculated a proxy measure for the NICE quality standard by combining the percentage of patients considered to require therapy, the percentage of days on which each therapy was received, and the number of therapy minutes received per day.

Patients: The benchmark for levels of patients requiring therapy is 80% for occupational therapy, 85% for physiotherapy and 50% for speech and language therapy.    This has been derived using data collected in previous rounds of stroke audit and has proved to be consistent at national level in SSNAP periodic reporting.

Minutes: In line with the NICE quality standard, the benchmark is 45 minutes of therapy provided per day 5 days a week.   If a patient receives therapy 7 days a week the benchmark is equivalent to 32 minutes per day.

Days: In line with the NICE quality standard, an adjustment is made to the total number of days on which therapy was received to approximate the number of working days by multiplying by 5 out of 7 (approximately 70%). 

Note: SSNAP collects data on whether a patient was considered to require therapy at any point in the admission and does not reflect whether the patient required or was able to tolerate therapy on each day. 

To improve performance in the therapy domains, teams may need to improve one or more of the 3 elements.   Taking national level results for occupational therapy for Dec 2016 - Mar 2017 as an example,

• 84.1% of patients nationally were considered to require therapy
• a median of 40 minutes of therapy was provided per day (based on 7 day week)
• therapy was delivered on 63.6% of inpatient days.

These figures show that the proportion of patients considered applicable is in line with the expected level of 80% and the number of therapy minutes across 7 days exceeds what would be recommended across this time period (target for 7 days = 32 minutes) if the NICE quality standard was extrapolated.  The proportion of days on which therapy is provided is also almost in line with the NICE quality standard of approximately 70%.   

With limited resources to achieve equilibrium between patients, days and minutes, the goal is to maximise the use of resources to benefit the highest number of patients throughout their stay.