Occupational Therapy Assessment Research Articles

Occupational therapy and decision-making capacity assessment: A survey of practice in Ireland.

The aim of the study was to explore occupational therapy practices regarding decision-making capacity assessment and to examine factors that impact on engagement in this area. Occupational therapists in Ireland were invited to participate in a cross-sectional online questionnaire. One hundred and seventy-two occupational therapists responded. 65.77% (n=98) reported that occupational therapy plays an important role in capacity assessment in their workplace. Occupational therapists most frequently contributed to decision-making capacity assessment for independent living (79.19%, n=118), driving (45.89%, n=67) and financial management (44.44%, n=64). Many participants reported that this is more difficult than other aspects of practice and that they are not satisfied with decision-making capacity assessment proceduresin their workplace. A large majority (91.86%, n=113) reported occupational therapists would benefit from additional training and practice guidelines in the area of decision-making capacity assessment. The study confirms that occupational therapists have a role to play in the multi-disciplinary assessment of decision-making capacity. The results of the survey suggest that decision-making capacity assessment is complex and challenging. Factors such as confidence, education and training impact on engagement with this area of practice. There is a need to develop education resources and guidelines for occupational therapists.

283 Does a Pen and Paper Assessment of Executive Skills Correlate with Functional Decline Identified Through Specialised Occupational Therapy Assessment?

Abstract Background Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia. Methods Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor & Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen & paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis. Results 22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman’s Rho correlation (-.2). Results did not identify a strong correlation Conclusion Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor & process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia.

10 Playing Our Part - Are The Occupational Therapists Completing A Comprehensive Geriatric Assessment?

Abstract Background 10% of people over 65 years have frailty, rising to between a quarter and a half of those over 85. Comprehensive Geriatric Assessment (CGA) is the gold standard for the management of frailty in older people; it’s a process that involves a holistic, interdisciplinary assessment of the older person. Evidence shows that CGA is effective in improving outcomes for older people. The National Clinical Programme for the Older Person outlines the role of the occupational therapist in CGA. A clinical audit was completed to investigate whether the occupational therapists in the Medicine for the Older Person service are adhering to guidelines for CGA. Methods Following a literature review, a retrospective audit of occupational therapy (OT) initial assessments was completed using paper count method. Data pertinent to CGA OT assessment was collected. Audit results were presented to the OT team alongside a CGA education session. A re-audit was completed, using above methods. Results 10 inpatient initial assessment forms reviewed pre and post audit. Activities of Daily Living Assessment: Pre result: 60% Post Result: 90% Home Environment: Pre: 80% Post: 100% Performance Components Assessment: Vision: Pre: 90% Post: 100% Hearing: Pre: 80% Post: 100% Upper Limb: Pre: 70% Post: 100% Mood: Pre: 60% Post: 80% Cognition: Pre: 90% Post: 100% Sleep: Pre: 70% Post: 80% Social Assessment: Pre: 60% Post:90% Falls Assessment: Pre: 60% Post: 90% Drving: Pre: 60% Post: 90% Conclusion This audit identified that the occupational therapists in the medicine for the older person service were not CGA compliant. CGA training now forms an important part of our OT induction programme. We are now “playing our part” in CGA with improvements in all domains. CGA is now commonplace practice within our team, in line with international and national best practice guidance for management of frailty.

Overview of the assessment practices of occupational therapists working in Quebec

In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented. This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles. A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec. In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties. Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.

The Use of Occupational Therapy Assessment Tool by Occupational Therapists in Long-term Care Hospital

The Use of Occupational Therapy Assessment Tool by Occupational Therapists in Long-term Care Hospital

Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review.

Background. Fatigue is one of the most invalidant symptoms of Multiple Sclerosis (MS) that negatively affects occupational and work performance and social participation. Occupational therapy (OT) assessment and treatment of impairments related to fatigue can have a significant and positive impact on the quality of life. Methods. An umbrella review has been carried out to provide rehabilitative decision makers in healthcare with insight into the role of OT in fatigue management in Multiple Sclerosis. The question is, what type of treatment provided by occupational therapist is more effective in reducing fatigue in Multiple Sclerosis? A search of literature published until June 2018 was undertaken by three independent reviewers using PubMed, PEDro, and Cochrane Library database including systematic reviews and meta-analyses of the last 10 years. Results. 10 studies were selected (5 systematic reviews, 1 meta-analysis, 3 reviews, and 1 guideline). Conclusions. Fatigue management programs have moderate evidence; other strategies such as OT strategies and telerehabilitation show low evidence.

Patterns of Social Skill Difficulties in Young Children with Reduced Social Competence: Parent and Teacher Perceptions

ABSTRACTThe purpose of this study was to explore social skills of young children with reduced social competence, from the perspective of parents and teachers. The study adopted a descriptive, quantitative design using secondary data from occupational therapy assessment information on 241 children. The data were collected using a parent and teacher questionnaire based on the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis. Factor analysis techniques were used to explore conceptual groupings amongst 24 social skill items. Social skills of children with reduced social competence were categorized into four behavioral constructs: emotion and resilience, pro-social behavior, intrapersonal capacities and friendship-making skills.

국내 아동 작업치료사의 평가도구 사용 동향

목적 : 본 연구는 국내 아동 작업치료사들이 사용하고 있는 평가도구를 영역별로 구체화하여, 평가도구의 사용 동향을 파악하고자 하였다. 연구방법 : 본 연구는 아동 작업치료사를 대상으로 평가도구 사용에 대한 설문을 실시하였다. 평가도구의 하위영역은 작업수행, 일상생활활동, 교육, 놀이, 감각-지각, 운동 및 실행, 인지, 사회적 상호작용 기술, 발달, 이학적 검사로 구성하였다. 설문에 응답한 105명의 자료를 대상으로 기술통계 및 빈도분석을 사용하여 분석하였다. 결과 : 본 연구 결과는 초기 평가 시 소요되는 시간은 30∼60분(41.9%)이 가장 많았으며, 재평가 주기는 3~6개월(41.0%) 로 가장 많이 실시하는 것으로 나타났다. 영역 별 평가도구를 살펴보면, 작업 수행은 Canadian Occupation Performance Measure(55.2%)을, 일상생활활동은 Wee Functional Independence Measure(57.1%)을, 교육은 School Function Assessment(2.5%)를, 놀이 평가도구는 Revised Knox Preschool Play Scale(28.6%)을, 감각-지 각은 Developmental Test of Visual Perception(94.3%)을, 운동 및 실행 평가도구는 Bruininks-Oseretsky Test of Motor Proficiency-2(42.9%)를, 인지 평가도구는 Lowenstein Occupational Therapy Cognitive Assessment(11.4%)를, 사회적 상호작용 기술은 Evaluation of Social Interaction(6.1%)을, 발달은 Denver Developmental Screening Test-II(92.4%)를, 이학적 검사는 임상관찰(89.5%)을 주로 사용하는 것으로 나타났다. 결론 : 본 연구를 통하여 국내 아동작업치료사들이 사용하고 있는 평가도구를 영역별로 구체적으로 파악할 수 있었으며, 이를 통해 추후 평가 교육 및 개발을 위한 기초적인 근거자료가 될 것으로 기대된다.

Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review.

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.

Defining the Needs of Elder Ex-Offenders Integrating Into the Community

Abstract Date Presented 4/20/2018 This study generated occupational profiles of elder ex-offenders to define their goals, prioritized roles, performance abilities, health concerns, and patterns of community engagement. Comprehensive occupational therapy assessment can delineate the challenges to occupational adaptation of elder ex-offenders. Primary Author and Speaker: Jaime Phillip Muñoz Additional Authors and Speakers: Moira Miller, Yinao Wang

Clinic for Multimorbidity

Introduction: Every fourth person suffers from more than one long-term disease multimorbidity, rising with increasing age. Everyday-life of multimorbid patients is influenced by difficulties in managing their conditions, complex drug regimes and attending multiple appointments in a fragmented health system. Thus, multimorbid patients experience lack of coordination and interdisciplinary care management. Typically, GPs have coordinated the patient's treatment. An expressed need exists for more cooperation and continuity. Practice change implemented: By establishing Clinic for Multimorbidity at a regional hospital, we enabled joint-assessments of multimorbid patients. Patients are referred by their GP. Prior to the patient's appointment, a physician reviews previous records and plan relevant medical investigation. At arrival, the nurse collects information, a pharmacist reviews the medication, followed by physiotherapy and occupational therapy assessments. The physician then has a collating consultation. Afterwards, a multidisciplinary conference involves relevant specialties, providing a joint treatment plan. The GP can participate by videoconference. The final treatment plan is agreed, the patient referred back to general practice and the nurse ensures necessary homecare. The consultations are gathered same weekday and schedules are coordinated by the nurse. Aim: To offer a holistic overview of multimorbid patients with complex problems, and to support GPs in care coordinating. Population and stakeholders: Multimorbid patients constitute the target population. Stakeholders include GPs and hospital healthcare professionals. Timeline: Clinic for Multimorbidity was established May 2012 and since then, data has been collected. Highlights: Clinic for Multimorbidity involves healthcare collaboration, knowledge sharing and shared treatment plan. In total, 141 patients have visited the clinic. Females constitute 60% and median age is 70 years IQR=63:77. Circulatory 20%, endocrine 10% and respiratory diseases 9% are most frequent. In median, patients has a usage of 11 drugs IQR=7:15. General health, physical and mental wellbeing is low compared to other groups, scoring 25, 26 and 42 on SF-12, respectively. Patients wait 31 days IQR=20:50 from referral to final assessment. Before the consultation, a median of four examinations IQR=3:5 are conducted and four medical specialties IQR=3:5 are represented at the conference. Sustainability: The clinic delivers a comprehensive status on the patient and coordinates different treatments giving an ideal onset for future treatment plans. However, diseases change over time making it difficult to sustain. Transferability: Practicalities of organizing the clinic are manageable and can be transferred to other hospital settings. This demands close collaboration between healthcare professionals and prioritizing of a resource-consuming intervention. Conclusions: It is feasible to establish an organization and collaboration targeting patients with multimorbidity. The novel approach focus on patient's needs instead of mono-targeting diseases and support the GPs in coordinating comprehensive trajectory for this patient group. These complex patients require involvement of several disciplines and professions and the hospital-based approach with all specialties in one place ensure few contacts for the patient and would not be achieved by outgoing teams. Discussions and lessons learned: Multidisciplinary approaches are called for and initiatives should consider setting aside fast-track care when handling multimorbid patients, due to disease complexity. Future effect evaluation on ex. healthcare use is planed.

Linking occupational therapy models and assessments to the ICF to enable standardized documentation of functioning.

The International Classification of Functioning, Disability and Health (ICF) can serve as reference for standardized documentation of health in clinical practice. This study aims to bridge the gap between the ICF and occupational therapy specific concepts, represented by occupational therapy models and their derived assessments. Occupational therapy assessments in relation to their models were systematically linked to the ICF, and a compatibility analysis was conducted. To strengthen reliability of the linkings, feedback from the respective assessment hosts was obtained. Linking tables were developed for the Assessment of Motor and Process Skills, the Canadian Occupational Performance Measure, and the Model of Human Occupation Screening Tool. Similarities and differences between the ICF and the three assessments and their associated models show how they differ from and complement each other. The findings of this study lay the foundation for standardized documentation in occupational therapy and enhance the practicability of the ICF.

Cognitive aspects of social competence in the current New South Wales Kindergarten to Grade Six Syllabuses.

Occupational therapists are commonly referred children who find reduced social competence a barrier to participation in school activities. Little is known about the social skills expected of children at school and the thinking strategies children use during social interactions. This study aimed to investigate the social skills expected of children during school-based learning activities in the current NSW K-6 Syllabuses and the types of cognitive strategies expected during social interactions. A qualitative text-based approach was adopted to explore the range of social skills expected of children at school. A content analysis of text-based data was used to identify specific social skills represented in the current NSW K-6 Syllabuses and the types of cognitive strategies required. Cognitive strategy use items from the PRPP System of Task Analysis were used to identify expected ways of thinking that related to social competence outcomes as stated in the Syllabus. Findings revealed a high number of social skills represented in expected learning outcomes for all six subjects included in the analysis. Four categories representing expected social behaviours across the syllabuses were identified: intrapersonal skills: communication by language; interpersonal skills and responding to others. Each desired social competence phrase embedded within syllabus objectives aligned with at least one item from the PRPP System of Task Analysis. The highest representation of expected strategy use was items from Recall (memory) and Planning (problem solving and evaluating) Quadrants. Investigation into the types of cognitive strategies embedded within Syllabus objectives which relate to social competence can assist therapists more accurately target social skills and associated cognitive strategies required for occupational performance at school. Findings from the study support the use of the PRPP System of Task Analysis for identifying and addressing cognitive strategy use during occupational therapy assessment and intervention.

What do clinicians consider when assessing chronic low back pain? A content analysis of multidisciplinary pain centre team assessments of functioning, disability, and health.

Beyond expert suggestions as to the appropriate subject matter for chronic pain assessments, little is known about the actual content of multidisciplinary pain centre (MPC) clinical assessments. The International Classification of Functioning, Disability and Health Low Back Pain Core Set (ICF LBP-CS) provides a universal language to support the consistent description of LBP-related assessments across disciplines within multidisciplinary teams (MDTs). This study sought to map the content of MPC clinical assessments to the ICF to: (1) identify and compare the content of clinical MDT assessments using a cross-disciplinary framework and (2) examine the content validity of the LBP-CS. A qualitative examination of MPC team clinical assessments of chronic low back pain was undertaken. Multidisciplinary team (pain medicine, psychiatry, nursing, physiotherapy, occupational therapy, and psychology) assessments were audio-recorded and transcribed. Concepts were extracted from transcripts using a meaning condensation procedure and then linked to the ICF. Across 7 MDT assessments, comprised 42 discipline-specific assessments and 241,209 transcribed words, 8596 concepts were extracted. Contextual factors (ie, the person and environment), except for physiotherapy, accounted for almost half of each discipline's assessments (range: 49%-58%). Concepts spanned 113 second-level ICF categories, including 73/78 LBP-CS categories. Overall, the findings revealed novel insights into the content of MPC clinical assessments that can be used to improve health care delivery. International Classification of Functioning, Disability and Health-based assessment profiles demonstrated unique contributions from each discipline to chronic low back pain assessment. Finally, users of the LBP-CS can be confident that the tool exhibits sound content validity from the perceptive of MDT assessments of functioning, disability, and health.

Predictive Value of the Cognitive Performance Test (CPT) for Staging Function and Fitness to Drive in People With Neurocognitive Disorders.

The Cognitive Performance Test (CPT) is a standardized occupational therapy assessment that examines cognitive integration with functioning in an instrumental activities of daily living context. Conventional cognitive measures provide diagnostic utility but do not fully address the functional implications. Ninety-one veterans diagnosed with cognitive impairment were evaluated. We compared the predictive value of the CPT with the Large Allen Cognitive Level Screen (LACLS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) for the need to retire from driving versus ability to pass an on-road exam. Measures were also analyzed by diagnostic classification. CPT correctly classified a mild versus major neurocognitive disorder, whereas MMSE, MoCA, and LACLS did not differentiate the groups. A CPT cutoff score of <4.7/5.6 showed 89% sensitivity for failing the road exam and 75% specificity for ability to pass. CPT discriminated functional level in neurocognitive disorders and had better predictive value for fitness to drive compared with conventional cognitive measures.

Examining Driving and Participation 5 Years After Traumatic Brain Injury.

Participation is often considered a primary goal of traumatic brain injury (TBI) rehabilitation, but little is known about the influence of driving on participation after TBI. The objective of this study was to examine the independent contribution of driving status to participation at 5 years post TBI, after controlling for demographic, psychosocial, and functional factors. Participants ( N = 2,456) were community-dwelling individuals with moderate to severe TBI, age 18 to 65 at time of injury, and enrolled in the TBI Model Systems (TBIMS) National Database (NDB). Hierarchical linear regressions for the dependent variable of participation at 5 years post TBI were performed. Findings showed that driving was a highly significant independent predictor of participation and was a stronger relative predictor of participation than FIM® Cognitive, FIM® Motor, and depression. The independent contribution of driving to participation suggests the need to develop evidenced-based occupational therapy assessments and interventions that facilitate safe engagement in the occupation of driving to address the long-term goal of improved participation.

Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study

BackgroundComprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.MethodsThe CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.ResultParticipants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment − 0.80 [95% CI 1.06, − 0.57], occupational therapy assistive devices − 0.73 [95% CI 1.00, − 0.47], discharge planning −0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, −0.02]. Controlling for documented risk assessments, the intervention had for falls − 0.94 [95% CI 1.08, − 0.08], nutrition − 0.87 [95% CI 1.06, − 0.67], decubitus ulcers − 0.94 [95% CI 1.08, − 0.80], and ADL status − 0.80 [95% CI 1.04, − 0.57].ConclusionThe CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.Trial registrationClinical Trials ID: NCT02773914. Registered 16 May 2016.

Association between older adults’ functional performance and their scores on the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)

Purpose The paper aims to investigate if the performance of older adults on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were associated or predictive of their functional performance in a geriatric evaluation and management (GEM) inpatient hospital setting. This will inform the occupational therapy assessment and management of older adults admitted to sub-acute GEM settings. Design/methodology/approach In all, 20 participants (11 men, 9 women, mean age 82 years, SD = 6.93) were recruited from a GEM ward in an Australian hospital. Participants’ cognitive abilities were assessed using the MMSE and MoCA, and their functional performance were assessed using the Functional Independence Measure (FIM). Spearman’s rho correlations and linear regression analyses were completed. Bootstrapping was applied to the regression analyses to accommodate the small study sample size. Findings No statistically significant correlations were obtained between the total and subscale scores of the MMSE and FIM or between the total and subscale scores of the MoCA and FIM. In other words, the cognitive and functional abilities of older adults admitted to a GEM setting were not significantly associated in this study. Originality/value The findings suggest that the MoCA and the MMSE were not predictive of participants’ functional performance as measure by the FIM in a sub-acute GEM setting. Occupational therapists should be cautious when interpreting participants’ MMSE, MoCA and FIM results and not depend solely on these results in the goal setting and intervention planning processes for clients on GEM wards. Further studies are recommended to confirm these findings.

Occupational Therapy Interventions for People With Alzheimer’s Disease

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer's disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

Optimising the Comprehensive Geriatric Assessment

Introduction: Carew House Day Hospital is an outpatient assessment unit for patients aged 65 years and over and is operated by the Medicine for the Elderly service in St. Vincent’s University Hospital (SVUH). Patients attending Carew House undergo multidisciplinary Comprehensive Geriatric Assessment (Medical, Nursing, Physiotherapy, Occupational Therapy and Social Work) with further access to Speech and Language Therapy, Dietician and Smoking Cessation services as required. The service assesses approximately 600 new patients annually. The National Clinical Programme for Older People advocates a Comprehensive Geriatric Assessment (CGA) of frail older patients as a means to increase independence in the home and reduce inappropriate admissions to nursing homes. Short Description of Practice Change Implemented: Deficiencies in the CGA were identified and discussed at a meeting of the Day Hospital Management involving medical, nursing and allied health staff. These deficits were demonstrated through an initial pilot and retrospective review of patients assessed in the Day Hospital. It was recognised that additional resources and staff for the Day Hospital would not be an available option to alleviate this problem. Once deficits in the CGA were identified and outlined, staff were empowered to engage with the change process immediately in order to develop improvement solutions. Aim and Theory of Change: The aim of this project was to empower members of the multidisciplinary team (MDT) to generate efficiencies within the service and to identify areas where the CGA could be streamlined. In December 2014, the following interventions were implemented: A new vetting process for patient referrals to ensure appropriate MDT members would be available on the date of assessment Nomination of designated nurse leader and senior clinician in the absence of regular staff An additional and timely referral pathway for physiotherapy and occupational therapy assessment using pre-existing additional community services Alternative access routes for medical social work input involving redesign of the referral pathway Targeted Population and Stakeholders: This included all patients assessed in Carew House Day Hopsital and all members of the MDT. Timeline: September 2014 - April 2015 Highlights: Having a Consultant’s clinical opinion directly available for each patient increased from 79% to 88%. The presence and input of a Nurse Manager on the day of assessment increased from 30% to 99%. Completion of Physiotherapy and Occupational Therapy assessment for patients increased from 65% to 73%, and 96% to 99% respectively. In addition to these improvements in the CGA, systems were implemented to ensure that a senior clinical opinion (Registrar or Consultant) was available at all times via telephone and a Deputy Nurse Lead was appointed in the absence of a Nurse Manager. An additional 15% of patients received Physiotherapy assessment via the newly implemented alternative referral pathway. Comments on Sustainability: It is recognised that while this suite of interventions has resulted in progress, our service is in constant need of review and regeneration in order to continue to improve for our patients. Comments on Transferability: This change process engaged staff across the MDT and highlighted that positive change in a service is achievable through improving efficiency and redesigning processes, without budgetary expansion. This model is transferable. Conclusions: Changes in Carew House Day Hospital resulted in improvements in the constituents and overall quality of the CGA for our catchment community. Discussions: While this project resulted in some improvement, the main barrier encountered was in recognising the deficits in our service that required change. Lessons Learned: Resource limitations should never stand in the way of improvement!