Outcome measures
Feature about functional improvement to achieve this .
This is not to discount or diminish the rehabilitative benefits occupational therapy within the acute setting can provide .
This project has strongly suggested that acute occupational therapists do bring about functional improvements for patients they see , using a variety of methods , and in any early regular rehabilitation , which can be provided while a patient is awaiting transfer to a longer-term rehabilitation setting .
But this is a benefit of a comprehensive and holistic acute inpatient service , not its primary goal , which must be to influence the patient pathway for swift and effective discharge from an acute bed to the most appropriate setting .
Evaluating an acute service on its ability to bring about functional improvement is therefore inconsistent with its purpose .
Additionally , the interviews with staff following completion of the project reflected a unanimous reluctance to use a tool that does not ‘ add value ’ to the service .
While all agreed the AusTOMs was easy to use and integrate into practice , following a predictable ‘ teething period ’ while coming to grips with the tool , staff could not see the value that this , or any other outcome measure , could bring to an acute service .
In addition , results from outcome measures are not requested routinely to demonstrate the efficacy of the acute occupational therapy service within The Walton Centre .
Like many other acute services across the country , we experienced a significant increase in temporary staff in order to respond to the COVID-19 pandemic , without the need to demonstrate objectively why this staff would be required .
It was assumed , based solely on the understanding of the primary purpose of the occupational therapist in the acute hospital setting , that those teams providing expertise in patient flow and discharge planning would be those most needed to ensure hospital beds were made and kept available , while preventing unnecessary re-admissions .
Staff also did not see any intrinsic value in using an outcome measure . They did not feel that their clinical decisions were influenced in any way by using an evaluation tool . It was simply ‘ another piece of paper ’ that , even when positive outcomes were demonstrated , did not provide any meaningful addition or significant reassurance to day-to-day practice .
Staff were satisfied that sound clinical reasoning and reflection are adequate strategies to reflect efficacy and performance within an acute inpatient service .
Sustaining the use of any outcome measure that is based on the evaluation of a change in functional performance would be extremely difficult if there are no perceived benefits to the patient , service , profession or organisation .
The value of existing occupational therapy outcome measures , including the AusTOMs-OT , is well evidenced across many settings . However , this service evaluation project suggested that generalising the use of current recommended occupational therapy outcome measures , all of which principally measure functional improvement , to the acute inpatient setting may be more challenging , given the brief nature of patient contact .
R
Enderby P , John A , Petheram B ( 2006 ) Therapy outcome measures for rehabilitation professionals . West Sussex : John Wiley & Sons Ltd .
James S , Corr S ( 2004 ) The Morriston Occupational Therapy Outcome Measure ( MOTOM ): measuring what matters . British Journal of Occupational Therapy , 67 ( 5 ), 210 – 216 .
Kiresuk TJ , Smith A , Cardillo JE ( 1994 ) Goal Attainment Scaling : applications , theory and measurement . New York : Psychology Press .
Law M , Baptiste S , Carswell A , McColl MA , Polatajko H , Pollock N ( 2014 ) Canadian Occupational Performance Measure Manual . 5th ed . Canada : CAOT Publications ACE .
Mahoney FI , Barthel DW ( 1965 ) Functional evaluation : The Barthel Index . Maryland Medical Journal , 14 , 56 – 61 .
National Institute for Health and Care Excellence ( 2018 ) Chapter 31 – Enhanced inpatient access to physiotherapy and occupational therapy . Emergency and acute medical care in over 16s : service delivery and organisation . [ NG94 ]. London : NICE .
Perry A , Morris M , Unsworth CA , Duckett S , Skeat J , Dodd K , Taylor N , Reilly K ( 2004 ) Therapy outcome measures for allied health practitioners in Australia : the AusTOMs . International Journal for Quality in Health Care , 16 ( 4 ), 285 – 291 .
Unsworth CA ( 2000 ) Measuring the outcome of occupational therapy : tools and resources . Australian Occupational Therapy Journal , 47 , 147 – 158 .
Words AMANDA CHESTERTON , Occupational Therapist , The Walton Centre NHS Foundation Trust
February 2022 OTnews 41