Outcome measures
Feature
Audit Committee in March 2021 . Its aims and objectives were to :
• establish if measurable outcomes are regularly observed within an acute inpatient setting
• ascertain the nature of intervention and appropriateness of referral for those cases where a demonstrable outcome is not captured by an outcome measure , and thereby develop a service profile of assessments and interventions used that demonstrate the need for occupational therapy , without necessarily leading to observable change in patient performance
• provide staff with a case-by-case means of reflecting on the efficacy of their practice , ensuring they are adhering to the principles of occupational therapy and evaluating their interventions accordingly
• determine if the introduction of an outcome measure within the acute inpatient service is feasible , appropriate and worthwhile .
Selecting an outcome measure
The following requirements were identified as essential to an outcome measure for use in an acute inpatient setting :
• can be used for patients with a wide range of presentations
• quick to use
• integrates with numerous methods of working and existing methods of documentation
• does not require users to radically change what they are doing in order to optimise the success of the integration of the tool into day-to-day practice
• inexpensive
• proven validity and reliability . We investigated and considered the following outcome measures for use within the acute setting : the Barthel Index ( Mahoney and Barthel 1965 ); the Canadian Occupational Performance Measure ( Law et al 2014 ); the Morriston Occupational Therapy Outcome Measure ( discussed in James and Corr 2004 ); Goal Attainment Scaling ( Kiresuk et al 1994 ); the Therapy Outcome Measure ( Enderby et al 2006 ); and the Australian Therapy Outcome Measures for Occupational Therapy ( Perry et al 2004 ).
Following further investigations and literature searches into all the above measures , the Australian Therapy Outcome Measures for Occupational Therapy ( AusTOMs-OT ) emerged as a frequently referenced measure , both in academic papers and in online discussion forums . It was also felt to meet the above identified requirements most fully .
In addition , the AusTOMs-OT provided the benefit of professional specificity , meaning that outcomes can be expressed that reflect the breadth and scope of the occupational therapy role , not simply generic outcomes based on isolated areas .
It enables a measure of patient / client satisfaction to be undertaken with or without the need for the patient / client to self-rate , and it interfaces seamlessly with assessment methods and other outcome measures that may already be being used .
Introducing and using the measure
Following agreement within the acute inpatient occupational therapy team to take part in this project , all qualified staff were trained in the use of the AusTOMs-OT .
Assistant staff were included in training sessions , as they were tasked with managing the paperwork associated with the project , and because an understanding of the tool would aid their organisation and planning .
Following training , qualified staff were asked to complete admission and discharge AusTOMs-OT scores for every new patient referred to the acute inpatient service within the six-week time period identified for the project , in addition to the usual assessment and treatment processes .
Qualified staff were also asked to complete a short questionnaire for each patient to explain any lack of observed outcome , to further illustrate if and why the patient was still an appropriate referral to occupational therapy ( or not ), despite a lack of observable / measurable outcome .
What did we find ?
Upon completion of the data gathering , I carried out one-toone interviews with each qualified member of staff involved in the project to obtain their subjective views on the benefits and costs of the tool .
A total sample of 73 patients were evaluated using the AusTOMs-OT . A measurable outcome was seen for 40 of these patients . For 21 of them , no measurable outcome was seen , but the referral was still considered appropriate . And for 12 people it was considered an inappropriate referral .
For the patients where a measurable outcome was
February 2022 OTnews 39