A comparison between reported and ideal patient-to-therapist ratios for stroke rehabilitation

Objective: Major improvement has been made in the medical management of stroke in the UK between 2008 and 2010 based on the indicators measured in the National Sentinel Audit. However based on the same audit, no corresponding improvement has been effected to patient functional impairment levels on hospital discharge in the corresponding time frame. This study derived patient-to-therapist ratios as a means of exploring the amount of rehabilitation time for stroke patients while in hospital care. Method: A purpose specific survey was developed for completion by stroke teams. From a contact list compiled primarily in collaboration with the 28 National Stroke Improvement Networks, the N name technique was used to target stroke teams in each geographical area covered by the 28 networks. Results: A total of 53 surveys were returned representing 20 of the 28 network areas providing 71% national coverage. Analysis conducted on 19 of the 37 inpatient hospital care units that were discrete units, had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and unit occupancy rates. Staffing levels for some therapies were below the Department of Health staffing assumptions suggesting that stroke units are challenged to provide the recommended therapy time. Conclusions: Most stroke units surveyed are operating below the DH staffing assumption levels and are therefore challenged in providing the amount of therapy and patient time recommended in the National Institute of Clinical Excellence guidelines to facilitate optimal functional recovery for stroke patients.