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Enhancing inpatient rehabilitation journey

Enhancing inpatient rehabilitation journey

What is inpatient rehabilitation?

Patients often require some form of rehabilitation following surgery or a major health event (eg a heart attack of stroke). The purpose of rehabilitation is to restore some or all of a patient’s physical, sensory, mental, and functional capacities that are lost due to their injury, illness or disease.

What are we trying to achieve?

It is important to understand the level of interaction and active practice that our rehabilitation patients receive as:

  • research shows that patients in stroke rehabilitation units spend very little time in therapy and a large percent of their day inactive and alone[2]
  • current guidelines recommend that for patients undergoing active rehabilitation, physical therapy (physiotherapy and occupational therapy) should be provided as much as possible with a minimum of one hour of active practice per day

Our aim is to enhance the journey for patients on our stroke rehabilitation units by identifying opportunities to provide more daily social and cognitive engagement.

What did we find?

We conducted a one-day audit on one of our rehabilitation wards to observe patients during their therapeutic day (8am-4.30pm which equates to 8 ½ hours per day). From the results we observed that patients spent on average:

  • 3 hours inactive/sedentary
  • 30 minutes in active 1:1 therapy
  • 20 minutes in group activity
  • 20 minutes carrying cognitive activity (eg reading, music, crosswords)
  • 15 minutes doing independent exercise

The audit showed that patients are not receiving recommended amount of daily occupational therapy or physiotherapy with little opportunity for patients to participate in physical, social or cognitive activities outside their usual therapy sessions.

Results from a one-day observational audit of patients during therapeutic day
Results from a one-day observational audit of patients during their therapeutic day (8am-4.30pm) on a rehabilitation ward

What have we done?

Workshops were held to explore innovative ways to optimise the use of non-therapy time and to understand the importance of maximising the use of non-therapy time by:

  • increasing activity levels and minimising functional decline
  • ensuring patients are engaged in more physical activity and are socially and cognitively stimulated

New initiatives

1. Dog therapy

  • We have introduced pet therapy which has been shown to help patients physically, emotionally and socially
  • Doug and his golden retriever ‘Harper’ visit the ward every Thursday

2. Lunch group

  • We now have a lunch group in the communal dining/lounge area which provides an opportunity for patients to socialise, spend time away for the bedside and also for incidental mobilisation

Lunch group
Lunch group

3. Exercise groups

  • We now run two extra exercise groups daily to increase opportunity for physical therapy

4. Quiz sessions

  • A daily quiz session is run in the afternoon to encourage social and cognitive engagement

Did we make a difference?

We have received very positive feedback from patients about the dog therapy:

Feedback on dog therapy
Dog therapy

Where to from here?

  • We are investigating the use of volunteers on rehabilitation wards to assist in supporting social/ cognitively stimulating groups
  • We are planning a repeat observational audit in early 2017 to investigate the effect of the initiatives already implemented