What the hell difference does that staff time have when complete recovery from stroke is 10%? You are pointing out the wrong problem, The real problem is your head is buried so far up your ass you will never see daylight and all the fucking problems in stroke needing to be solved. What is worse is that attendees will nod their heads and agree with such fucking poor research conclusions. God, what a pile of blithering idiots supposedly working for stroke survivors.
HYDERABAD, INDIA — Work organizational factors and not patient
factors were the major determinants influencing the frequency and
intensity of the provision of therapy to acute stroke patients, a
qualitative case study series involving UK stroke units finds.
"So
in this study it was very striking. It wasn't about patients and their
fatigue or their readiness or their ability [to participate in
therapy]," David Clarke, PhD, lecturer in stroke care at the University
of Leeds, United Kingdom, told delegates here at the World Stroke
Congress (WSC) 2016. "It was work organizational factors" that were the
major barriers to provision of care.
He said established working
practices and professional cultures can be resistant to change but may
be addressed through patient-focused work reorganization and staff
development using methods of service improvement.
Studies have
shown that increased frequency and intensity of therapies are associated
with improved outcomes in the first 6 months after stroke. In the
United Kingdom, the recommendation is for 45 minutes daily, 5 days a
week, of occupational, physical, and speech-language therapy each.
However, national audits consistently report that these targets are not
being met. The Recommended Amount of Active Therapy (ReAcT) study set
out to discover the reasons.
The investigators studied eight
National Health Service stroke units in England, performing about 1000
hours of general observations and 434 patient-specific observations.
They analyzed therapy records and performed semi-structured interviews
with staff and patients/caregivers. Among the units observed, there were
hyperacute, acute, and rehabilitation units, and a mixture of types,
with the number of beds ranging from 24 to 68.
Audit ratings
ranged from AAA to DDD, with a mix of in-between ratings based on number
of daily minutes in which patients received each of the three kinds of
therapy. Only two units achieved an AAA rating.
Among 77 patients
typical of stroke unit residents, 49 were interviewed, as were 50 of 53
caregivers and 130 of 193 staff. Staff members were 16% male, and the
group had a mean age of 35.6 years.
Staff Factors Biggest Impediments
The
researchers found seven major factors affecting the provision of care
to patients: organization of the therapists' working day, time spent in
non–patient contact activity, patient factors, staffing levels and
deployment, limited use of timetabling of therapy, limited knowledge of
evidence for increased frequency and intensity of therapy, and influence
of national audits.
The first two factors — both of a systemic,
organizational nature — were the greatest impediments to providing care
up to national standards. Across the eight stroke units, each staff
member spent 1.3 to 8.6 hours per day in non–patient contact activities
of information exchange among staff.
As one would expect, the
minimum time spent in information exchange was reflected in the audit
ratings. The worst-performing unit had a DDD rating, where workers were
spending 8.6 hours per day in non–patient contact activities. Staff in
the two units with AAA ratings spent 1.3 and 3.8 hours per day on such
activities. Staff time not spent talking to each other left more time
for patient therapy.
Exacerbating the problem, most units adhered to traditional 8-hour
work days, with the time available for therapy further eroded by
protected meal times, documenting therapy, and performing audit data
entry. Actual time available for therapy was less than 5 hours per day
for each staff member.
Staffing
levels in general were inadequate. Seven of eight units had less than
the number of recommended physical and occupational therapists, and all
eight were deficient in speech-language therapists.
Dr Clarke said
that there was limited evidence that the principle of "more therapy
more frequently is associated with better outcomes" influenced the
planning and delivery of therapy.
However, two units undertook
service reorganizations. One reviewed and substantially reduced the time
devoted to non–patient contact activities and also increased patient
contact time by extending the work day with staggering of start and
finish times. Both units simplified and standardized entry of audit data
and used national audit performance ratings in business cases to target
therapist staffing increases.
Only
one unit used electronic records, which provided a substantial
advantage in that paper-based units often required staff to enter the
same information on different forms up to three times whereas electronic
records could automatically repopulate the information.
Given the
magnitude of the problem, "a shift in therapists' thinking and practice
towards patient-centered rather than therapist-centered working in many
UK stroke units is required," Dr Clarke advised.
Session chair
Patrik Michel, MD, head of the stroke center at Lausanne University
Hospital in Switzerland, noted that the units were slightly
understaffed, but the main problem was that "the organization of their
therapy needs can be improved" to reduce workers' time on bureaucracy
and paperwork.
"Quality
improvement is always both an internal and external process," requiring
both internal quality improvement standards and systems as well as
external audits, he told
Medscape Medical News. "Of course, the
improvement process itself is at risk of creating bureaucracy, so the
internal audits should be both simple and be done without much
bureaucratic efforts."
Professor Michel said another interesting
finding of the study is that the professionally trained therapists
seemed not to be aware of the scientific evidence that more intensive
therapy leads to better outcomes. "So there is some work to be done as
well on that level," he said.
The study had no commercial funding. Dr Clarke and Professor Michel have disclosed no relevant financial relationships.
World Stroke Congress (WSC) 2016. Presented October 28, 2016.
