Every day is a learning opportunity and although ... it can be very stressful , the hustle and bustle and the variety of professionals we work alongside and absorb knowledge and skills from far outweighs the challenges of the role .”
Every day is a learning opportunity and although ... it can be very stressful , the hustle and bustle and the variety of professionals we work alongside and absorb knowledge and skills from far outweighs the challenges of the role .”
five-over-seven-day model and managing the gaps for staff on rest days for weekend working , time owed in lieu for the late shifts , annual leave , study and sick leave , as well as staff vacancies , taking into account national shortages in the profession and AHP staff retention .
To manage these challenges , the service agreed flexible working patterns and vacant bank shifts to be voluntarily worked by the team , which naturally welcomed by some , could increase the potential for staff burnout and a limited work-life balance .
During the COVID-19 pandemic , there was a change to national policy to facilitate timely discharges from the acute hospitals to protect the safety of patients .
NHS England ’ s ‘ Hospital discharge service policy and operating model ’, published in August 2020 , and later the ‘ Hospital discharge and community support guidance ’, adopts a Discharge to Assess and Home First approach to hospital discharge , expecting that most patients will go back home , or their usual place of residence , for a period of assessment before long-term placements are considered .
This removed the need for most functional assessments in the acute setting and for the patient to be ready for discharge as soon as their medical episode was complete .
Although this created specific professional challenges to the acute occupational therapy role and an initial blurring of roles and boundaries , it has also identified the importance and value of the profession within the setting . These significant changes have shaped current and future practice .
Challenges
The role of an acute occupational therapist is pertinent and advantageous to many , with multiple hospital discharges requiring input .
However , it can be difficult to follow through with recommendations and plans when some services work Monday to Friday , 9am to 5pm .
The occupational therapy team at Warwick has faced numerous challenges , including an aging population and higher prevalence of complex social circumstances . Public expectations of healthcare are high . Staff are concerned that they cannot fulfil these and this may lead to complaints or litigation .
Acute occupational therapists have had to adapt practices and use innovative ways to ensure safe and efficient patient discharges . Functional assessments were significantly reduced to avoid prolonged inpatient stays , although this impacted on team morale , as we were not practising our core fundamental skills .
National bed pressures in the NHS resulted in increased and disrupted flow across the hospital , with rapid patient movements across wards to meet infection prevention guidelines . This reduced occupational therapy continuity of patient care and so the team ’ s communication became paramount in the handover of patient discharge plans and goals to facilitate safe and timely discharges back into the community .
Previous winter pressures became an all-year round occurrence and resulted in extra capacity wards and beds across the trust . This put a further strain on staff capacity and resources , limiting physical space for clinical assessments and stretched community services .
This pushed forward innovative occupational therapy practices , including appropriate triaging to ensure patients received the right care at the right time . For example , sending pathway referrals when patients are medically optimised to avoid increased waiting lists and strain on community services .
Onward and upward
Several actions have been implemented to help provide the best occupational therapy service possible . Our functional assessments have reduced , as well as our site and home visits . In doing this , we help reduce prolonged inpatient stays and promote efficient patient discharge in line with the NHS England national driver , ‘ Why not home ? Why not today ?’
With the change in practice , we have expedited the clinical reasoning process and make clinical judgements based on the patient ’ s inpatient stay and care needs to directly refer to the appropriate discharge pathway .
This has meant the occupational therapy profession takes one of the leading roles in the discharge process for Pathways 0 and 1
34 OTnews September 2023