gms | German Medical Science

Clinical issue/s: Commonly non-qualified hand therapy assistants (HTAs) only complete prescribed rehabilitation with a limited cohort of patients. Due to departmental growth, increasing patient demand, limited resources and a drive for financial efficiency, the HTA role has been developed to provide high quality therapist directed care for a wider cohort of patients, to allow sustainability of service provision.

Clinical reasoning: The NHS five year forward view demands innovation to deliver care in a more financially efficient manner, without compromising standards of care. We have drawn from the WHO concept of 'task sharing' which encourages delegation of appropriately identified tasks to non-qualified staff making use of robust quality assurance mechanisms to ensure safe and efficient transfer of role and care.

Innovative, analytical or new approach: The scope of the extended role has been developed with supporting supervision, tailored training and robust safety nets. To safeguard patient outcome and safety, stringent clinical governance strategies have been applied in the form of, competency statements, pre and post assessment with qualified staff and a clear escalation process for concerns. The departmental capacity has increased to a level of 1 HTA: 5 qualified Hand therapists in order to fully realise this role. Elements of the extended HTA role include: review of patients with extensor tendon injuries, carpal tunnel decompression and tenolysis surgery, wound management, removal of sutures, plaster of Paris serial casting and k-laser.

Contribution to advancing HT practice: This model of extension of the HTA role may be replicated in other departments to promote both effective care and efficient use of resources.