Emily Cook, a Therapy Team Lead, Allied Health Professional (AHP) from North East London Trust (NELFT) has discovered how the Shared Care Record can support in the decision making of a patients therapy pathway.
The challenge
Prior to the introduction of the Shared Care Record, we often had limited information regarding a patient’s previous therapy input, progress, or outcome measures. Without a detailed history of their rehabilitation journey, it was difficult to form a comprehensive picture of their baseline function and potential for improvement.
Recently, a patient was admitted to our ward who had previously attended a local neuro-rehabilitation inpatient unit. On admission, the patient was very bed-dependent, and historically we would not have had access to their earlier therapy outcomes. However, through the Shared Care Record, I was able to review outcome measures and progress data from their previous neuro-rehabilitation stay. This included information about their therapy input, Barthel Index scores, and the timescale of their recovery.
This insight provided valuable context regarding what level of functional improvement had previously been achieved, and over what duration- albeit under a different neurological condition and within a more intensively resourced setting. Sometimes it can be challenging to gauge a patient’s true potential for recovery, as progress is influenced by a number of factors such as motivation, the therapy environment, physical health, and wider psychosocial circumstances. Access to these previous outcome measures, from an admission one year prior, allowed us to better understand the patient’s historical rehabilitation journey and to use this as a reference point in our current clinical reasoning.
Accessing shared information
Through the Shared Care Record, I was able to confirm that during their previous admission it had taken approximately 12 weeks for the patient to progress from a similar baseline level of mobility. Given that our current inpatient rehabilitation service has an average length of stay of 2–3 weeks and operates with lower staffing ratios compared to specialist neuro-rehabilitation units, this data enabled a more realistic appraisal of what could be achieved within our current setting.
Rather than using the Shared Care Record as a day-to-day planning tool, it acted as an additional resource to support clinical reasoning- helping me to evaluate rehabilitation potential, adjust expectations, and ensure that goals were both achievable and meaningful within our service parameters.
Interestingly, in our setting the patient was able to return to mobilising, though not to the same level previously achieved at the neuro-rehabilitation unit. After six weeks, the patient progressed from being bed-bound to mobilising with a rollator frame and the assistance of two staff members. By comparison, during their earlier admission they had achieved mobility independently using a tripod stick after 12 weeks.
This was a valuable point of reflection, as the patient themselves had expressed a strong wish to return to their previous baseline level of independence. Had we fully utilised the shared information ahead of goal planning, we could have used it to set more realistic and collaborative expectations from the outset- supporting both patient motivation and goal alignment across the multidisciplinary team.
Impact and outcomes
Access to this shared data helped to:
- Identify clinical trends and patterns across different rehabilitation environments, providing useful context about how the patient had previously responded to therapy.
- Inform clinical reasoning and goal-setting, supporting the creation of goals that were realistic, measurable, and meaningful within our current service’s timeframe and available resources.
- Enhance multidisciplinary communication by providing shared reference points that ensured consistent expectations across the team and with the patient’s family.
- Encourage reflective practice, helping to compare the outcomes achieved in a more intensively resourced neuro-rehabilitation unit with what could be realistically achieved in a frail and elderly inpatient rehabilitation setting.
The difference it made
Although the Shared Care Record was not extensively utilised at the initial time of the patient’s admission, on reflection it is evident that it could have been used more proactively to support goal-setting and expectation management. Early engagement with the data would have helped facilitate more open, informed conversations with the patient regarding their rehabilitation potential and the likely timescale of their progress.
This reflection has highlighted the Shared Care Record’s potential as not only a data resource but also as a clinical reasoning and communication tool, supporting the development of therapy plans that are both evidence-based and person-centred.
Learn more about the Shared Care Record