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Abstract
Occupational therapists (OTs) are at the forefront of providing recovery-oriented care for older people through timely assessments of patient’s engagement in daily living activities among many other interventions. This aids a timely, safe and successful discharge from hospital.
This project built on the foundations of previous work while considering the context and requirements of two older adult wards, the rates of admission and staff retention. The specific aim agreed was for 90% of patients admitted to the older adults’ inpatient units to be assessed by the occupational therapy (OTY) team within days of admission by December 2022.
The OTs worked in collaboration to initiate two tests of change with a total of five PDSA cycles.
Our tests of change resulted in an increase of patients engaging in OTY initial assessments within seven days of admission from 47.65% (May to November 2021) to 78% (December 2021 to December 2022).
Our team embarked on a quality improvement project to improve standardisation, efficiency and timeliness of the OTY process in an older adult inpatient service by using a pragmatic measure and tests of change evidenced in a previous study. This evidenced the generalisability of the findings of this study. While we were able to improve the timeliness of OTY initial assessments, we concluded that the overall impact on outcomes such as timely discharge was also dependent on other clinical and social factors.
- improvement
- quality
- audit
- clinical
- sustainable development
- older adults
- occupational therapy
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
A previous paper described an improvement in the standardisation and efficiency of the occupational therapist (OT) admission process but was limited because of a lack of balancing measures and an objective measure of sustainability.
WHAT THIS STUDY ADDS
Our paper provides a clear and replicable account of how improvement in an OT admission process was achieved using quality improvement approaches with balancing measures and an objective measure of sustainability.
HOW MIGHT THIS STUDY AFFECT RESEARCH, PRACTICE OR POLICY
It produces a reflective account on how collaboration, system thinking and iterative learning within psychologically safe environments can produce sustainable improvement.
Problem
The National Health Service long-term plan for older people admitted to an acute mental health unit posits that a therapeutic environment provides the best opportunity for recovery.1 It postulates that when care is purposeful, person-centred and recovery-focused right from admission, patients will have a better care experience and lead to better outcomes such as reducing unnecessary time spent in inpatient acute settings.
Inpatient occupational therapists (OTs) are at the forefront of the provision of a therapeutic environment and recovery-oriented care for older people by encouraging person-centred daily routines and activities that improve their quality of life.2 Such interventions empower older people by recognising, promoting and enhancing their abilities to meet their own needs, problem solve and providing the agency to organise the resources for their recovery.3 Providing older adults with opportunities to be independent and maintain an active lifestyle is important for an ageing population who want to live well.4 As such, OTs have a vital role in aiding the functional recovery of older adults and the preservation of their independence, values, autonomy and rights through recovery-oriented practices.5
Timely person-centred standardised and non-standardised functional assessments which provide a means of examining the patient’s abilities to engage in and complete living daily activities.6 7 Such assessments also aid a timely, safe and successful discharge from hospital by indicating the need for home visits with the view of assessing mobility concerns and the suitability of the home environment for the patient’s level of functioning.8
The older adult inpatient service discussed consists of two wards. The occupational therapy (OTY) workforce across the two units consists of one clinical lead, two band 6, two band 5, two preceptees (newly qualified OTs) and six OT assistants. The OT team provide a seven-day therapeutic service including a range of ward-based functional and cognitive assessments and interventions aimed at maximising the patients’ participation in their daily activities and routines while on the ward.
Despite the benefits of timely assessment and the current offer of a diverse therapeutic environment, the older adult acute inpatient OT teams within this trust had difficulties in a maintaining standardised approach for timely OTY initial assessments. A process mapping exercise indicated that the OTY process was neither present nor standardised. As a result, the understanding of the OTY process in terms of the timeliness of the initial assessments was not clear. Likewise, assessment and treatment responsibilities were not clearly defined between OTs and OTAs indicating a lack of efficiency in the use of staff resources within the process.
Although we set out to improve the timeliness of the OTY process, it was clear that we needed to develop a standardised process, improve its efficiency by ensuring a clear allocation of responsibilities between our OTs and OTAs to ensure that the OTs had enough resources to complete their initial assessments.
With team working together, the OTY team developed a quality improvement (QI) project to standardise the OTY process and increase its efficiency and the timeliness of the initial assessments of patients during admission and built on a previous QI project.9
To achieve this, we had the following objectives:
Create a standardised OTY process.
Ensure that 90% of patients admitted to the older adults’ inpatient units are assessed by the OTY team within days of admission by December 2022.
Define the responsibilities of OTs and OTAs throughout the OTY process.
Design balancing measures to analyse the impact of admission rates and staff retention on the timeliness of initial assessments.
Background
Older adults aged 65 years and over account for approximately 11 million people—(19%) of the total population10 and it is anticipated that one in four older adults live with a common mental health condition. There is also a significant prevalence of mental health conditions from older people accessing healthcare services. It is estimated that 40% of older people in primary care live with mental illness, increasing to 50% in general hospitals and 60% of those in care homes.11 An analysis of the current rate of admission of older adults with mental illnesses posits that on an ordinary day within a 500-bed hospital, older adults account for 60% (330) of the beds.12 Within this number, 44% (220) will have a mental health disorder of some kind: 20% (100) will have depression, another 20% (100) will have dementia and 13.2% (66) will have delirium.
Older adults accessing inpatient mental health services often have specific requirements from morbidities associated with mental and physical health and how they impact each other. Indeed, evidence indicates that older adults with a prior level of physical health is a leading indicator of subsequent change in mental health, and the prior mental health state is the leading indicator of subsequent changes in physical health.13
Therefore, to aid timely treatment and discharge within this population, timely OTY initial assessment is vital to assess functioning within daily living activities, identifying physical health concerns, proposing therapeutic interventions and assessing the environmental safety of the discharge destination in a timely manner.6–8
This project aimed to build on the foundations of previous research9 by improving timely initial assessments of patients’ abilities to engage in living daily activities to achieve recovery-oriented care in an older adult service. This was done with the belief that these assessments will ultimately aid a timely and safe discharge with consideration to the mental and physical health needs of this population.9 It further developed the previous QI project by defining the role of OT and OTAs in two distinct ways. First, it provided an opportunity to use this approach in a different trust and identify different considerations that may be needed for an older adult inpatient population. Second, it provided an opportunity to improve the efficiency of carrying out initial assessments and standardised the use of an alternative person-centred assessment for patients who were too unwell to engage in initial assessments.
Measurement
How the information was acquired
The OT lead audited the timeliness of initial assessments from May 2021 until November 2021. As a result of a lack of a standardised OT process, the team agreed that the timeliness would be measured based on Accreditation for Inpatient Mental Health Services(AIMS) standards for older adult inpatient service 2.2.5,14 which posits that admitted patients should have an initial mental health assessment which is started within 4 hours and completed within seven days of admission. A score of 1 was given for initial assessment in seven days and a score of 0 when initial assessment did not occur in the same period.9 The number of days that it took to complete initial assessments was also recorded to improve the sensitivity of the measurements of any tests of change that were implemented. In situations where initial assessments were not completed throughout the length of stay of a patient in hospital, we agreed to put the average length of stay of patients on the older adult service for 2021 which was approximately 31 days.
An audit revealed that a significant amount of OTY initial assessments for patients in these units were not being completed in a timely manner. The audit indicated an average score of 32% on ward A and 63.3% on ward B from May until November 2021 when the initial assessment was completed in seven days. The percentage compliance can be viewed in table 1.
Baseline audit for initial assessments on ward A and ward B
Design
The baseline audit motivated the OTY team to embark on a QI project to standardise and increase the timeliness, effectiveness and efficiency of the OTY admission process. The QI team consisted of a Divisional Lead OT (Project Lead), a band 7 clinical lead OT, two band 6 OTs and two band 5 OTs. The QI team used monthly meetings to discuss the implementation of tests of change and work in collaboration to find solutions to any challenges faced during the project. The QI team held the first three business meetings with the Divisional Lead OT (one in October, November and December 2021). The remainder of the business meetings throughout the project were led by the clinical lead OT to encourage local leadership. The clinical lead OT was supported with monthly supervision by the Divisional Lead OT to encourage the continuity of the project. The OTY team also agreed to engage in focus groups mid-project and the end of the project. This was proposed to gather in-depth insights into the challenges and successes of the project.
During the business meetings in October and November 2021, the OTY team discussed the barriers and solutions that could improve the timeliness of the initial assessments in the admission process (see table 1 in online supplemental file 1). We used the findings from these meetings to create a driver diagram which formed our theory of change for the project (see image 1 in online supplemental file 1) and identified the first change idea that we would test to initiate the project.
Supplemental material
Impact of number of admissions and staff retention on occupational therapy initial assessment completed with 7 days of admission
Strategy
Test of change: standardising the time to conduct initial assessments
The OTY team initiated this test of change on both wards in the older adult inpatient service from December 2021 until December 2022. The plan to start with both wards was because the OT staff on both wards were eager to implement the changes and imbibe good practices that were already in existence in silos on both wards. We met monthly within business meetings and produced a monthly audit to monitor the impact of the test of change and corresponding Plan-Do-Study-Act (PDSA) on both wards. We used team meetings to discuss any learnings from the PDSA cycles to further develop the test of change.
We discussed the progress of the project and first test of change in our clinical reference group (CRG) and the Clinical Operations Assurance Team meetings (COATs) for the older adult wards to promote wider service and trust engagement. These meetings consisted of clinical leads, matrons, heads of nurses and operational managers for the older adult inpatient services. This ensured that the clinical and operational leadership structure were able to understand the project, offer invaluable support and embed the project into practice. The matron for the older adult service was included in the project on the QI online platform15 and progress of the project was discussed in monthly meetings with the area service manager.
The project team decided that creating a standardised and efficient process was the first step to understanding the needs of older adults in a timely and standardised manner leading to the creation of more opportunities for subsequent service provision that is more person centred. Likewise, standardised time to conduct the OTY initial assessment is a good foundation before introducing any further changes to service provision.16 See image 2 in online supplemental file 1 for an illustration of this process.
PDSA 1: create a standardised and efficient OTY process (December 2021)
Plan
The team process mapped out our OTY process from previous guidance to ensure efficient and effective prioritisation of OTY resources.17 This included outlining the details, timelines and pathways of patients from admission to discharge based on AIM standards for older adults’ inpatient services (see images 3–8 in online supplemental file 1).
Do
Once the OTY process was created, the admission process was standardised with a timeframe of seven days to complete the initial assessment on both wards based on the AIMs standards for older adults. This included a designation of tasks for the OTs and OTAs during the admission process to improve its efficiency (see tables 3 and 4 in online supplemental file 1). The team agreed for the clinical lead OT to complete monthly audits to measure the percentage of assessments that were completed within seven days of admission. The audit was completed at the end of the month to capture all admissions starting from December 2021.
Study
The audit indicated an increase in initial assessment on ward B from 57.1% in November 2021 to 81.8% in December 2021 and to 100% in January 2022. The frequency of initial assessments on the ward A decreased from 60% in November 2021 to 25% in December 2021. This increased slightly to 33.3% in January 2022.
Act
A discussion indicated that OTs on ward B (with high initial assessment scores) believed that their early success was due to the allocation of caseloads to both OTs on the ward B by the band 6 OT. We agreed to implement allocation of caseloads for the OTs on ward A as a PDSA. This will replicate this effective process on ward B.
PDSA 2: allocation of caseloads of patients to OT staff on ward A to standardise the admission process (February 2022)
Plan
Feedback from the first PDSA about the difference in timely initial assessments from both wards was attributed to a caseload allocation process during the admission of patients. Ward B had a system for band 6 OTs to allocate caseloads to band 5 OTs. This gave them the responsibility of conducting assessments within the seven days based on a defined caseload. The clinical lead OT planned to support the OTs on ward A to pick up caseloads by giving them the freedom to distribute caseloads equally among themselves. The team decided to improve scores on ward A to 50% for February 2022 and ward B to maintain 100%.
Do
The clinical lead implemented a plan that all patients in ward A were allocated to an OT on admission. Once a patient was admitted on ward A, a band 5 OT added such patient to their caseload. This meant that the band 5 OT was responsible for their assessment, treatment and discharge.
Study
The monthly audit score in ward A went up from 33.3% in January to 66.7% in February but went down to 18.2% in March. On ward B, the monthly audit scores of 100% was maintained in February but went down to 71.4% in March. It was speculated that the reason for this was that both wards had a band 5 and 6 leave their positions for career progress within the Trust. The data highlighted a possible impact of staff retention on timely assessments.
Act
The team agreed to monitor the data from the beginning of April until the end of May to analyse if the audit scores would improve alongside recruitment. This was done to establish the impact of recruitment on timely initial assessments. In April, the initial assessment scores on ward B increased to 100% but reduced again to 71.4% in May 2022. On ward A, the scores increased to 50% in April 2022. The score of 50% was maintained in May 2022. It was noted that both wards employed new band 6 OTs in May 2022.
PDSA 3: standardising alternative ways of gathering information for the initial assessments (June 2022)
Plan
Information from a focus group conducted in May 2022 (see table 5 in online supplemental file 1) to discuss the progress and challenges of this improvement project revealed that ward A OTs were struggling with the initial assessment for new types of patients who are more elated and unwell. This made it challenging to complete the assessment in seven working days while ensuring the person-centredness of such assessments. Their approach had been to wait for an improvement in their mental state which typically delays the timeliness of their initial assessments. This delay impacted the timely identification of personalised support needs, such as home visits, further comprehensive assessments and information for best interest meetings.
The ward B OTs supported the ward A to learn from their system because they typically admitted patients who could not engage in their initial assessment because of their poor mental state. They had been able to complete the initial assessment by using an alternative assessment form to collate information about the functioning of patients from family members, patient records, carer and care coordinators to complete a person-centred assessment. The OTY team for both wards constructed a standardised flow chart as part of the OTY process for both wards to clearly indicate the steps to follow if patients cannot engage in their initial assessment.
The team targeted an increase in the number of initial assessments completed within seven days of admission on ward A to an average of 60% by the end of June 2022. The team also agreed that ward B would maintain the previous month’s result of 70%. The team agreed these targets were realistic because of the introduction of a new way of completing initial assessments on ward A and due to the vacant band 5 OT positions on both wards.
Do
The clinical lead constructed the flow chart as part of the standardised OTY process, which included two options of assessments based on the clinical presentation of patients.
Option 1: if a patient could engage in the initial assessment—OTs to use the inpatient assessment of occupational needs.
Option 2: if a patient was too unwell on admission to engage in the initial assessment—OTs to use baseline OT assessment and gather information from the Inreach Home Treatment Teams, Community Psychiatric Nurses (CPN) and patient records (SystOne notes). OTs would review the assessments when the patient could engage.
Study
Ward A’s percentage of initial assessments increased to 66.7%. Ward B’s score increased slightly to 72.7%. Increase in scores on ward A was attributed to the alternative assessments for patients that were struggling to engage because of poor mental health. Ward B was already used to the alternative assessments. Therefore, as predicted, there were no significant impact on timeliness of assessments.
Act
The OTY team discussed a plan to support band 6s to complete the monthly audit for their teams. This will encourage local leadership and accountability within each ward and provide more in-depth explanations for the increase or decrease in audit scores for initial assessment within seven days. This will also aid sustainability of the project.
PDSA 4: supporting band 6 OTs to use the audit tool (July 2022)
Plan
To teach the band 6 OTs how to complete the audits on their wards. This will encourage local leadership and accountability. This also encouraged local leaders to identify any concerns impacting the timeliness of initial assessments in the older adult wards. The team set a target for an increase in initial assessments to 70% on ward A. While ward B set a target to maintain a score of 70% for July’s initial assessment.
Do
The clinical lead trained the band 6 OTs to audit their respective services. This was carried out in a group supervision session. A score of 1 was given to initial assessments completed in seven days. A score of 0 was given to assessments not completed in seven days. The number of days taken to complete the assessment and reasons for delayed assessments were also recorded as part of the audit.
Study
Both wards scored 100% for their initial assessments in July 2022. The clinical lead enquired about what was responsible for this significant improvement in scores. Both wards acknowledged that the band 6s had not been completing auditing yet. They intended to start at the beginning of August. Ward A’s OT explained that they had a manageable caseload of four patients and that they had an alternative assessment for patients who were too unwell to engage as implemented in PDSA 3. Ward B had a high number of admissions (11 patients) but still managed to achieve 100% initial assessment within seven days of admission. They attributed this to striving to complete the initial assessments right from the first day of admission.
Act
Since this PDSA was not completed, it was agreed that band 6 OTs will start auditing their wards and audit data would be monitored in August and September 2022. In August 2022, 100% of patients were assessed within seven days of admission on ward B and 75% of patients on ward A. OTs on ward A were not able to assess all their patients within seven days as outlined in the OT process because they were waiting for patients to recover enough to be able to engage with their initial assessment. The team agreed that this issue had been discussed previously and an alternative assessment had been added to the OT process to ensure that initial assessments could be completed using information from carers, family and the community team. We agreed that the clinical lead OT would discuss this in subsequent business meetings.
Second test of change (induction of new OTs into the OTY process)
PDSA 5: creating an induction pack about the OTY process for new OTs (October 2022)
Plan
The clinical lead OT constructed an induction plan to ensure that new OTs recruited into vacant posts during the project understood the standardised OT process and clinical reasoning behind the timeliness of assessments. This included education and clear description of the admission process as part of the induction plan for new starters. It also included the defined roles of OTs and OTAs throughout the OTY process. We agreed on a target that OTs will support 90% of patients on ward B and ward A to complete their initial assessments within seven days of admission.
Do
The clinical lead OT completed the induction pack which detailed the OTY process and PDSAs that had been completed as part of the QI to improve the timeliness of the OTY initial assessment. This was presented to newly recruited OTs in their ward induction. A copy of the OTY process was given to the OTs so that they could refer to it while working with patients.
Study
The audit indicated that 100% of patients were assessed within seven days on ward B and 71.4% on ward A. The reason why ward A did not meet the prediction of 90% was explored. It was identified that there was a staff sickness, and, in another case, the OTs did not use the alternate initial assessment when the patient was not well enough to engage.
Act
The clinical lead agreed to engage ward A OTs and discuss the use of the alternative assessment to gather information for the patients who are unwell. The team also agreed to move to the sustainable stage of the project and use learnings from the previous PDSAs.
Results
The results indicated an increase of initial assessments completed within seven days of admission from 63.3% (May to November 2021) to 92.1% (December 2021 to December 2022) on ward B. Likewise, initial assessments on ward A increased from 32% to 63.9% during the same period. Overall, timely initial assessments increased from 47.65% to 78%. Table 2 details the impact of the number of admissions and staff retention on OTY initial assessment completed with seven days of admission. Images 9–12 in online supplemental file 1 detail the impact of each PDSA cycle such as trends and shifts.
As suggested in a previous study,9 the impact of the rate of admission and staff retention on the timeliness of initial assessments was measured. During this project, we noted that the rate of admissions did not impact the timeliness of initial assessments. Likewise, it could not be inferred immediately that staff retention impacted the timeliness of admission when a month where an OT position was vacant was compared with the next. For example, in January 2022, when the band 6 OTs on both wards left their posts for other posts within the trust, this did not impact the percentage of initial assessments for January. When two band 5 OTs moved on to other roles in March 2022, the percentage of initial assessments dropped significantly but then improved significantly in April 2022. However, with the recruitment of band 6 OTs on both wards, the percentage of initial assessments completed monthly increased consistently. This continued with the employment of band 5 OTs until the end of the project.
Despite the observed consistency in the increased percentages of initial assessments which occurred when band 6 OTs were recruited, it could not be ascertained that there was a direct link between both occurrences. The improved times in assessment could be due to multiple factors such as improved understanding of the OTY process, better understanding of the OT and OTA roles as the project progressed, new PDSA cycles and the recruitment into band 5 and 6 roles.
Finally, we applied the NHS England and NHS Improvement Sustainability Model18 to assess the sustainability of the process in the areas of staff, process and the organisation at the beginning, middle and end of the project. A total score of 92.9 indicated optimism for the future sustainability of the project (see images 13 and 14 in online supplemental file 1). This has also been evidenced through continued improvement in the timeliness of initial assessments 5 months after the completion of the project (images 15 and 16 in online supplemental file 1).
Lessons and limitations
Engagement and collaborative approaches
This project highlighted the importance of having formal and informal opportunities to collect insights, feedback throughout all stages of a QI project, from understanding the problem to the study and act aspects of PDSA cycles.19 It exemplifies the importance of timely and continuous feedback that allows a truly iterative approach to designing, testing and refining changes to practice. It is certainly the case that this multifaceted strategy provided opportunities for people from different levels and disciplines to provide valuable insights and meaningful engagement into this project.
Process mapping provided a novel opportunity to enhance engagement and the potential for change in this project. This included the detailed process mapping—a tool to understand practices and context19 20—provided us with an opportunity to gain a better understanding of our current OTY practices and understanding the contexts in which there may need to be adaptions made to maximise outcomes. As well as being a systematic and robust tool, it helped us enhance engagement and teamwork by supporting a shared insight into OTY process in a logical way understood by the OTY team and wider stakeholders such the matron, heads of nursing and area service manager.20–22 In this sense, it provided an opportunity for a multidisciplinary team to openly discuss the status of the process and coalesce around what needed to be done. The benefits of this tool and our approach meant that we were able to systematically understand the different contexts for the two wards described and all have a shared sense of what needed to be done and a shared purpose.
This collaborative and meaningful approach improved the ability for the OTY teams to form an informal small community of action to learn best practices from each other, including things that did not go so well and ideas for next steps. This was particularly important in this project as it helped OTs to understand the importance of context in understanding what would best serve different patient populations. This was evident in a focus group where it was discovered that the use of alternative person-centred assessments was common practice on ward B but not on ward A, which accounted for the patient acuity and what was best for the support that they require. Sharing this learning in an open and candid way allowed ward A to adopt the learning from ward B and provide a more consistent approach to meeting patients where they are in their recovery journey rather than having a blanket approach, irrespective of specific needs. This involved acquiring collateral history from those who support the patient as part of the triangle of care to inform the baseline OTY assessment.23
Sustainability and implementation into practice
We focused on sustainability based on previous research.9 This involved carrying activities in practice-focused manner across the tests of change described and following the principles developed by the Royal College of Psychiatrists.24 This project did not incur any extra financial, social or environment costs. This was achieved by discussing and running PDSA cycles within pre-established OTY business meetings and spreading the multidisciplinary team awareness of this project through pre-established CRGs and COATs meetings. Likewise, no extra OT or OTA posts were created to facilitate this project other than recruiting into pre-existing vacant posts.
To increase sustainability and embed the changes into practice, we produced an induction pack to ensure that all new OTs understand our processes for initial assessment for each ward. Additionally, we empowered band 6 OTs to carry out audit and monitor the timeliness of initial assessment and discuss the results in peer supervision sessions to enhance local leadership. These approaches of integrating successful projects into practice ameliorates any impact of changes being seen as an additional activity and just become business as usual.25
We explored the impact of this project on staff sustainability by exploring the impacts of changes on job satisfaction and well-being with the understanding that the nature of their work would play a vital role in the overall quality of their physical and emotional health.26 This is especially true when considering the current challenges of work-related stress and burnout within the NHS.27 Staff satisfaction and well-being was discussed and monitored in regular business meetings, one-to-one and group supervisions and focus groups halfway and at the end of the project (see Online supplemental file 1 in online supplemental file 1).
Finally, we recognised the importance of exploring ways to measure sustainability in improvement and used an established tool to consider this in the two wards supported. Changes to practice can act like elastic bands and retract back to the previous status quo if not properly integrated into practice and measured in an objective manner. Our use of the tool described helped us to check-in with teams and support them where required.
Limitations
Despite this study evidencing generalisability by using a pragmatic measure, established standards14 and tests of change evidenced in a previous study,9 a limitation to this project continues to be the generalisability of this study to other older adult settings. Factors to consider include staffing levels, psychological safety of staff involved in the project, impact of the multidisciplinary team, clinical leadership, senior leadership and environmental settings.
Likewise, we would have liked to ascertain the impact of timely OTY assessments on timely discharge, we concluded that timely discharge is dependent on multiple factors such as availability of placement beds (for patients on the care home pathway), social support, clinical recovery of the patient and the safety of their home environment. An area that future improvement could explore is how timely OTY assessments could translate to timely and effective treatment in the form of OTY care-planning and interventions and discharge planning.
Conclusion
We achieved the aim of the QI project, which was to standardise, increase the timeliness and efficiency of the OTY admission process. We also designed balancing measures to analyse the impact of admission rates and staff retention on the timeliness of initial assessments. This study builds on previous research9 and supports the importance of recovery-oriented practice and its importance for older adults.1 2 5
This project further supported the importance of a timely and standardised approach with the use of QI methodology as found in previous research9 coupled with evidenced-based prioritisation protocol17 based on the AIMs standards for older adult inpatient services.14 It is our hope that other OTs within older adult inpatient services can use this project as an example for other service development projects on timely processes within their settings while considering the context.
Using a continuous improvement lens, the next stage of this work is to use the findings of timely initial assessments to facilitate timely treatment interventions specifically home visits. This will enable the early resolution of safety and support concerns within the patient’s home environment and enable timely discharge.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Acknowledgments
The authors would like to thank Becki Priest (Chief of Allied Health Professions, Derbyshire Healthcare Foundation Trust), Sarah Wood (Area Service Manager for Older Adult Inpatient and Crisis Teams, Derbyshire Healthcare Foundation Trust), Anna Moss (Matron Head of Nursing for Older People’s Services, Derbyshire Healthcare Foundation Trust) and Kate Sales (Matron, Older People’s Inpatient Services, Derbyshire Healthcare Foundation Trust).
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors JJII wrote up this study. This included leading the clinical team to carry out the PDSA cycles and the collaboration involved. DFH reviewed the manuscript to ensure its suitability for submission. AM, EE, AW, RF, LK, AS, AG and BW wrote the description of the older adult service under the problem section as a team. They were also the clinical team who participated in this study and carried out the PDSA cycles. JJII as the guarantor of this study accepts full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.