Occupation

Abstracts Thursday 30th June 2016
condensation was used to analyse patient interview which was
then linked to the ICF using established linking rules (Cieza et al.,
2002, Cieza et al., 2005). Items with a frequency of >15% were
included in the framework. ICF categories from the Acute and
Post-Acute Core Sets (Grill et al., 2011, Grill et al., 2005a) were
combined to produce a list of 140 categories. These core sets
were developed for patients with musculoskeletal, neurological
and cardiopulmonary conditions. Patients with traumatic injuries
often have similar problems to these patient populations. In
agreement with the ICF research branch, these 140 categories
were presented to trauma experts in an on-line questionnaire
rather than using a Delphi survey typically used for ICF Core Set
development (Grill et al., 2005b). Experts rated the importance
and prevalence of ICF categories to determine the overall priority
of categories. Items with a prevalence and importance >70%
were included in the framework.
Results: Thirty five of 43 patients consented and participated,
identifying 234 (64%) from a possible 363 second level ICF
categories. Two hundred and seventeen (66%) international
trauma experts completed an on-line questionnaire identifying
121 ICF rehabilitation categories. Patients and HCPs strongly
agreed on items related to body structures and body functions
which include temperament, energy and drive, memory,
emotions, pain and repair function of the skin. Patients
prioritised rehabilitation tasks related to domestic tasks,
recreation and work compared to HCPs that prioritised selfcare
and mobility. Environmental is an important concept
not previously considered in trauma rehabilitation and 26
environmental categories were identified. Data was combined
and reduced to propose 109 candidate categories for ICF
Rehabilitation Framework for Patients with Major Trauma
Conclusions: Comprehensive assessment of function and
rehabilitation needs is important to for effective and patient
centred intervention. Moreover, standardised coded ICF
categories will enable categorisation and comparison of patient
assessment and outcome data. This will enable comparison
between individuals, regions and international trauma systems
to identify important rehabilitation gaps and needs amongst
trauma populations. An internationally applied ICF rehabilitation
framework for trauma will standardise the language used and
concepts measured to enable international comparison of
outcome data.
References
CIEZA, A., BROCKOW, T., EWERT, T., AMMAN, E., KOLLERITS,
B., CHATTERJI, S., USTÜN, T. B. & STUCKI, G. 2002. Linking
health-status measurements to the international classification of
functioning, disability and health. J Rehabil Med, 34, 205–10.
CIEZA, A., GEYH, S., CHATTERJI, S., KOSTANJSEK, N., USTÜN,
B. & STUCKI, G. 2005. ICF linking rules: an update based on
lessons learned. J Rehabil Med, 37, 212–18.
GRILL, E., EWERT, T., CHATTERJI, S., KOSTANJSEK, N. & STUCKI,
G. 2005a. ICF Core Sets development for the acute hospital
and early post-acute rehabilitation facilities. Disabil Rehabil, 27,
361–6.
GRILL, E., QUITTAN, M., HUBER, E. O., BOLDT, C. & STUCKI,
G. 2005b. Identification of relevant ICF categories by health
professionals in the acute hospital. Disabil Rehabil, 27, 437–45.
GRILL, E., STROBL, R., MULLER, M., QUITTAN, M., KOSTANJSEK,
N. & STUCKI, G. 2011. ICF Core Sets for early post-acute
rehabilitation facilities. J Rehabil Med, 43, 131–8.
Keywords
Adult physical health, Research, Pathways or models of service
delivery, NHS
Contact E-mail Addresses
karen.p.hoffman@gmail.com
Author Biographies
After qualifying in South Africa I moved to the UK to work and
travel. I have worked here for 16 years, mostly in acute and
neuro-rehabilitation as well as trauma. I have been chair for
COTSSNP, completed a masters in rehabilitation and recently
my PhD. I was on the guideline development group for the
new ‘Splinting for the prevention of contracture’ and several
NICE guideline group including Critical Care Rehabilitation and
Trauma Service Delivery.
Session 62.2
Developing a pro-active method of working in A&E
and AAU
Pears K, South Tees Hospitals Foundation Trust
The A&E Therapy Team was set up as a pilot in November 2012
specifically for A&E at the James Cook University Hospital.
Initially the team took a reactive approach, relying on A&E staff
to refer but it was noted that an increased presence of the
team in the department invited increased referrals. This led to
developing a pro-active method of working. This method has
now been introduced on the Acute Assessment Units.
The pro-active method involves either a Therapist or a Therapy
Discharge Facilitator being located in A&E/AAU for the majority
of the day the aim is to never leave for more than 30–45
minutes. All patients are screened based on age, diagnosis
and social situation. Patients likely to need therapy input are
identified at the earliest opportunity when medically fit or
sometimes prior to so that those ready for discharge can be
prioritised. The team challenges decisions to admit if services
exist in the community to meet the patient’s needs.
Over the course of the pilot when the pro-active method was
developed a 136% increase in the number of patients seen was
noted. Patient and staff satisfaction surveys were completed
showing a high standard of satisfaction: 100% of patients felt
it was of benefit to receive a therapy assessment in A&E rather
than at a later date.
This method of working is of benefit to similar services across
the country as it allows OTs to take control of their workloads
in fast-paced environments and shows that we are working to
the same timescales and objectives as other professions in these
departments. Patients are being discharged at the very earliest
opportunity with the correct services in place. This reduces
length of stay and as a result patients are less likely to lose
independence and be exposed to infection (DOH 2004). It shows
that OTs are valuable for getting patients, in particular older
people, in the right locations of care at exactly the right time.
This paper will present in detail the benefits of the pro-active
model.
References
Department of Health (2004) Transforming Emergency Care
in England – A report my Professor Sir George Alberti.London:
Department of Health.
Keywords
Adult physical health, Service improvement or transformation,
Innovative practice, NHS
Contact E-mail Addresses
kathryn.pears@nhs.net
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