The therapy intensity scoring system attempts to acknowledge teams who provide more minutes of therapy, to more patients, on more of the days they spend in hospital.
If your team has a low score on the therapy domains, it is important to review all three aspects to determine whether there is scope to provide more therapy to those who would benefit from it. With such complete, national, data providing a comparison in the public domain you can have detailed discussions with your managers and commissioners and put together an information pack with a proposal for how to remedy the areas concerned. This might be a business plan or a submission to the appropriate structures in your organisation which would identify where the gaps are and what resources might be required both from within your area and across the stroke unit or community multi-disciplinary team.
- First, review the percentage of patients your team has deemed applicable for therapy. If you have a low score on this key indicator, consider the reasons why this may be. If you believe your team has a markedly different case mix than other teams, you can review this information in the casemix tab of the results portfolio. (see snip below) If your case mix is not very different, you could review your patients to see if there are some who are currently not being included in the cohort who could benefit from receiving some therapy input.
- Secondly, review the average number of minutes per day of therapy received. If you have a low score on this indicator, consider whether patients are receiving enough input on the days they have therapy. Remember, all of the therapy on a given day does not have to be delivered in a single session. It may be more appropriate for the patient to accumulate more minutes overall by receiving, for example, 5 sessions of 10 minutes each on a given day, if they are unable to tolerate longer sessions. In addition, not all patients who are applicable for therapy will require 45 minutes in a day – some patients will require more therapy and some will require less therapy. This is why SSNAP takes the median performance for the indicator, so it is based on what the “middle” patient receives; it is not affected by patients who receive either lots or very little therapy.
- Thirdly, review the percentage of days in hospital (or when being treated by a community team) on which the therapy is delivered. If you have a low score on this indicator, consider whether many patients are going for many days without receiving any therapy input and what the reasons for this might be. For example you may not cover all the weekdays with therapy staff. It may be beneficial to the patient to receive smaller amounts of therapy on more of their days in hospital than to receive a single long session of therapy during their inpatient stay. Again, this indicator is based on the median performance, so it is not affected by outlying patients, but rather the “middle” patient.
- The stroke guidelines provides the evidence of the importance of providing intensive therapy which you can discuss with your managers.
Finally, if after reviewing your results you believe that more patients could benefit from more minutes of therapy on more of their days in hospital, but that there is not enough available therapy provision to achieve this, then consider reading about this issue in the NIHR study by David Clarke and case study by Dr Andrew Hill, these case studies can be found through the link below. https://www.strokeaudit.org/AnnualReport/Case-Studies.aspx
Issues you might like to consider
- Reviewing your therapy staffing levels in the latest SSNAP Acute Organisational Audit to determine whether your unit has lower staffing ratios than other similar teams for both therapists and therapy assistants.
- Reviewing the pattern of working for your therapists and therapy assistants
- Timetabling so that patients know when their therapy provision will occur
- Putting together a business case to increase the number of therapists routinely available to provide therapy (including considering 7 day working).