A comparison between reported therapy staffing levels and the department of health therapy staffing guidelines for stroke rehabilitation: a national survey

Abstract

BackgroundThis study compared reported staffing levels for stroke care within UK in-patient stroke units to stroke strategy staffing guidelines published by the UK Department of Health and the Royal College of Physicians. The purpose was to explore the extent to which stroke teams are meeting recommended staffing levels.MethodThe data analyzed in this report consisted of the detailed therapist staffing levels reported in the demographic section of our national survey to determine upper limb treatment in stroke units (the ATRAS survey). A contact list of stroke practitioners was therefore compiled primarily in collaboration with the 28 National Stroke Improvement Networks. Geographic representation of the network areas was obtained by applying the straight-forward systematic sampling method and the Nth name selection technique to each Network list. In total 192 surveys were emailed to stroke care providers around England. This included multiple contacts within stroke teams (e.g. a stroke consultant and a stroke co-coordinator) to increase awareness of the survey.ResultsA total of 53 surveys were returned from stroke teams and represented 20 of the 28 network areas providing 71% national coverage. To compare reported staffing levels to suggested DoH guidelines, analysis was conducted on 19 of the 37 inpatient hospital care units that had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and average unit occupancy rates. Only 42% of units analyzed reached the DoH guideline for physiotherapy and fewer than 16% of the units reached the guideline for speech & language therapy. By contrast, 84% of units surveyed reached the staffing guideline for occupational therapy. However, a post-hoc analysis highlights this as an irregularity in the DoH guidelines, revealing that all therapies are challenged to provide the recommended therapy time.ConclusionsMost in-patient stroke units are operating below the DoH guidelines and are therefore challenged in providing the recommended amount of therapy and patient time to facilitate optimal functional recovery for stroke patients.

Clinical swallowing prognostic indicators in patients with acute ischemic stroke

“…Until the early 2000s, stroke was considered an inherent risk of aging and was rarely prioritized in health systems 1 . However, in 2007, a change occurred that led to the development of processes aimed at improving the effectiveness and efficiency of procedures adopted for post-stroke patients 2 .…”

Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

“…Task shifting is introduced in various high-income settings such as the Netherlands, UK, New Zealand, Australia, Canada and the U.S. as a means of dealing with an anticipated personnel shortage. A move towards workforce reconfiguration is at the same time situated in the context of public service reforms that aim to increase flexibility in working practices and service organisation, decentralise health services from specialised to less specialised care and curb healthcare expenditures [ 3 – 6 ]. Evidence on quality, safety, effectiveness and efficiency is, however, mixed and depends on factors such as the specific nature of role revision, type of clinicians, organisational redesign, healthcare setting and clinical area as well as the broader financial and legal context [ 4 – 7 ].…”

FES-UPP: A Flexible Functional Electrical Stimulation System to Support Upper Limb Functional Activity Practice

“…In the United Kingdom there are more than 100,000 new stroke cases each year and approximately 1.2 million people living with the consequences of stroke ( Stroke Association, 2017 ). In the United Kingdom, during their entire in-patient stay, a typical patient will receive around 5 h of physiotherapy ( McHugh and Swain, 2014 ), with much of that time focused on the rehabilitation of posture, balance and walking ( Wit et al, 2005 ). The consequences of this are that patients do not receive anything approaching the intensity of upper limb therapy that research suggests is needed to drive functional recovery ( Clarke et al, 2015 ).…”