Enhanced rehabilitation step down service on Critical Care
A new service to help patients transition from Critical Care onto a ward at the Norfolk and Norwich University Hospital (NNUH) is being introduced this Autumn.
It comes after a successful trial last year, where an additional Rehabilitation Assistant joined the team to provide an extra element to the existing step-down service provided by the Recognise and Respond Team (RRT), following patients as they moved from Critical Care to wards.
Critical Care, which consists of Intensive Care and the High Dependency Unit, provides care for the sickest patients. Length of stay ranges from one day to several months and patients can be ventilated for most of that time. Once they no longer require ventilation and the high level of medical and nursing care they can be moved to a specialty ward.
The team of Rehabilitation Assistants work with patients in Critical Care and once they have moved to a ward. They provide rehab such as helping a patient get out of bed, get moving, and complete simple tasks such as brushing their teeth and hair. They work alongside Physiotherapists, Occupational Therapists and Speech and Language Therapists to ensure patients reach their goals in terms of personal care tasks, eating and drinking, weaning from ventilation and tracheostomy. They also deliver Sunshine Therapy, where they take patients for short trips outside of Critical Care, complete patient diaries and update patient boards with their likes and dislikes, which helps to deliver personalised holistic care.
Toni Bladon is Joint Clinical Lead Physiotherapist for Critical Care alongside Laura Grimsey. Toni said: “When patients move to the ward, it’s a huge transition for them because they’ve been used to 1:1 or 1:2 levels of care, and suddenly they go to the ward where there are more patients. The Rehabilitation Assistants support patients by being a friendly face, helping ease anxiety and assist them with general day-to-day activities, bridging the gap and enhancing the therapy they receive on the ward.”
Some patients who have been in Critical Care can be affected by Post Intensive Care Syndrome, which encompasses physical, psychological, emotional and social factors.
Toni adds: “Some patients can have symptoms that are purely from being on Critical Care. Our specialty ward teams are very good at looking after a patient’s particular condition, but sometimes the awareness of the impact of Critical Care is less well known about, so the Rehabilitation Assistants play a vital role in helping the patient feel comfortable on the ward and promote these specific needs.”
During the 14-week trial the team saw 206 patients. Of the most complex group of patients there was a reduced length of hospital stay by seven days, and patients were more mobile when they left hospital.
Tracey Humphrey, Rehabilitation Assistant, said: “It was lovely to see patients progress on the ward and they loved seeing a familiar face. We found that functional progression and the patient’s ability to improve their mobility was quicker because we knew what they could do on Critical Care, and we were able to encourage this on the ward very quickly.”
Feedback from patients, relatives and carers has been very positive after the trial. One relative said: “Zac and Tracey’s friendly faces helped with anxiety.” Another said the team “went above and beyond to make sure he didn’t feel worried.”
Deborah Easby, consultant in Anaesthesia and Intensive Care Medicine also praises the additional service. She added: “Our rehab assistants work across the whole multi-disciplinary team and are usually involved with our most complex patients in some aspect on at least a daily basis. Being able to take their knowledge of the patient and translate this to the ward environment supporting the patients, their families and the ward staff with this transition, is invaluable.”
A new team member has just joined the team and the step-down service will be re-launched from the end of October.