A therapy assistant in the intensive care unit

Purpose

To evaluate the use and impact of a Band 4 Therapy Assistant (TA) in supporting rehabilitation in Speech and Language Therapy (SLT) and Physiotherapy (PT) in an ICU.

Approach

Data was collected between July 2016 and Feb 2017 using a service evaluation design. The TA kept a timed, daily record of activities. These included patient related tasks e.g. hands on therapy and non-patient related tasks e.g. equipment management. Data was collected as to whether tasks were undertaken in place of a qualified staff member or whether it was in addition to the current service provision. Qualitative data, by way of quotes, was collected from the TA, therapists, other staff and the patients by a member of the therapy team.

Outcomes

Quantitative results were inputted into Microsoft Excel 2010 and analysed using descriptive statistics. The TA conducted, on average, 55 activities per week accounting for 86% of their working day. Sixty percent of all activities were patient related (n= 33). The remaining 40% (n=22) were non patient related, comprising of administrative or equipment management tasks previously performed by qualified staff. Of the patient related activities, 56% (n=18) were undertaken independently and 44% (n=14) as part of a joint treatment with other therapists. Sixty nine percent (n=23) of the patient related activities involved the TA completing the activity instead of a qualified member of staff, whilst 31% (n=9) were identified as an additional treatment. On average, the TA provided 13 hours of intervention per week instead of a qualified therapist, thus increasing the qualified therapist's capacity to perform other tasks and treatments. Feedback from the TA, patients and therapy staff showed a positive response to the role. Increased capacity to provide rehabilitation and education were the two themes that emerged.

Cost and savings

When costed, the use of the Band 4 TA when compared to a Band 6 saved the therapy service £96 per week, and £2882 during the 30 week data collection period. This figure can be extrapolated to an annual saving of £4995.

Implications

Introducing the role of the TA to the ICU was a new and innovative way of working for our therapies ICU team. From the results it can be seen that the benefits of having this role were on multiple levels. The role increases capacity for qualified therapists to direct their attention to more specialist treatments.. The extrapolated cost savings of £4995 per annum confirms that the role, and altered skill mix, can bring both added holistic value and cost efficiency.

Within this study positive qualitative feedback was also gained from therapists, the TA and other members of the MDT.

Future work should identify and develop specific competencies for TAs working in rehabilitation in the ICU.

Fund acknowledgements

The Royal Free London NHS Trust Intensive Care Unit funded the post.

Additional notes

This work was presented at Physiotherapy UK 2018