Rehabilitation Assistants in supporting the recovery of critical care step-down patients. This project was completed as part of the 2025 Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) Green Team Competition, implemented by the recognise and response team (RRT) team.
Team members:
Annie Sturrock, RRT Lead for Quality Assurance and Education.
Alanna Forrester, RRT Clinical Lead.
Laura Grimsey, CCC Clinical Lead Physiotherapist.
Setting / patient group:
Patients stepping down to the ward after spending >72 hours on critical care.
Issue:
Patients who have had a critical care admission experience a range of physical, psychological and cognitive impairments. Patients receive intensive therapy whilst on critical care, but this is reduced once stepped down to the ward. National guidance recommends a structured rehabilitation programme starts on critical care and should continue through to ward discharge. Our recognise and response team (RRT) review patients on day-1 following step-down from critical care but then are not reviewed on a regular basis. Ward therapists are relied on to continue rehabilitation, who are less resourced.
Aim:
To introduce structured rehabilitation support for patients who have spent >72 hours in critical care, to be delivered during the period after step-down from critical care until hospital discharge.
Intervention:
A 6-month trial was established where rehabilitation assistants continued to review patients who had spent >72 hours on critical care or had a complex admission, after their step-down to the ward. Three rehabilitation assistants rotated spending time on critical care and the wards, to maintain continuity of care and ensure the assistants knew the patients and understood their experience of critical care.
Outcomes:
Clinical Outcomes
Average length of stay from critical care discharge to hospital discharge reduced by 3 days, for an average of 578 patients annually.
Number of patients discharge back to their usual place of residence increased from 82%-83.73%.
No change in critical care readmission rates.
Ongoing access available to the RRT for any deterioration in condition.
Environmental Outcomes
64,598 kgCO2e emissions saved annually from reducing ward length of stay by 3-days for 578 patients (assistant commuting emissions factored in). The equivalent to driving 190,050 miles in an average sized car.
Financial Outcomes
£422,435 saved annually, based on saving 1,734 bed days (assistant salary factored in).
Social Outcomes
Positive patient mental health benefits from seeing ‘familiar faces’ on the wards, feeling supported, being taken outside, being discharged sooner.
Rehab assistants have greater understanding of patient journey.
Rehab assistants felt supported and valued in their role.
Key learning point
The implementation of this project has had a positive impact, reducing hospital length of stay in this patient group, having a positive social influence on patients and staff as well as the positive financial and environmental influence on the Trust.
Providing step-down therapy can improve physical and psychological recovery in this vulnerable group of patients.
Substantive funding for a full-time rehabilitation assistant has been secured, to continue to support this role.
The project has highlighted the need for Trust wide ward staff education, on the importance of continued rehabilitation in this patient group.
Further data needs to be analysed on physical ability, to identify if the rehabilitation is leading to reducing mobility aids or care packages on discharge.
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