Testing models of Integrated working in acute hospital wards to scope models of healthcare for the future.

Purpose

With a national picture of a shortfall of qualified nurses and continued NHS cost improvements, Sheffield teaching hospitals wanted to test using Integrated wards to scope new models of healthcare for the future. Aiming to be cost efficient, whilst delivering high quality care to patients and creating an improved working environment for staff. The project looked for ways to share skills and work more closely between the therapy and nursing professions, to avoid duplication, deliver the care patients need in a timely way and optimise time for each Profession to give their expertise to the patients who need it.

Approach

A band 6 Physiotherapist and Occupational therapist were recruited to work on a Urology surgical ward in October 2016 for 18 months to evaluate the service. A clinician led project trialled working patterns, what skills could be shared, joint therapy and nursing interventions for patients. They had weekly meetings to continually evaluate what was working to deliver excellent healthcare to the patients and what potentially wasn't. Their findings were regularly fed back to the Nursing and Therapy management with PDSA reports. Integrated wards were rolled out to 8 wards across Sheffield teaching hospitals to continue the work of testing potential models of delivering healthcare, from October 2018 to present. From November 2018 to April 2019 the Urology ward tested whether a newly qualified Physiotherapist could work in an Integrated way to ascertain if rotational band 5 therapists could fill these roles as part of their core rotations and how much Professional experience is required.

Outcomes

Qualitative and quantitative data was collected, which showed a reduction in falls, pressure care incidents, earlier therapy interventions, reduced delays to discharge, reduced nurse vacancies, increased staff skills and knowledge, improved quality of patient care. There was positive staff and patient feedback. Other factors could have also contributed to the findings, but during the Integrated wards projects improvements have been made. During the second phase of the project, a newly qualified Physiotherapist was able to deliver shared therapy and nursing skills but required a lot of senior therapy and nursing support. It was stressful as a newly qualified professional working on an Integrated ward for the first three months trying to learn so many skills whilst establishing their own Professional skills and identity.  

Integrated wards are a model that can potentially improve patient care and can continue to deliver excellent healthcare with nursing shortages and continued cost improvements. It creates an environment where the patient's clinical needs are met, but also a culture of reablement to maximise a patient's recovery. At least one rotation in your own Profession is required before delivering an Integrated role, unless it is based on a ward with lots of senior staff present.

Implications

Further work is required to test models of Integrated wards, each speciality will have different needs which will determine how and by whom the care is delivered most efficiently.

Fund acknowledgements

No external funding. Therapy posts paid for with current ward and therapy budgets.

Additional notes

This work was presented at Physiotherapy UK 2019