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PDSA. Richmond Hospital. Presented by: Bev Adamson (PT) Stephanie Chung (OT). PDSA Confidence : PLAN. What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital. PDSA Confidence : PLAN.

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Richmond Hospital

Presented by:

Bev Adamson (PT)

Stephanie Chung (OT)

PDSA Confidence: PLAN

What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital

PDSA Confidence : PLAN

Why: Assessing the patients’ confidence will give:

●an outcome measurement/patient satisfaction rating on how well the program has prepared the patient for discharge

● an indication where the program needs improvement

PDSA Confidence : DO

●Each patient, on hospital D/C will be asked to rate (0-10) their confidence in regard to mobility and ADL (managing at home)

● If confidence of 7/10 or less, the therapist asked for the concerning issues so they could be dealt with immediately.

PDSA Confidence : STUDY

Data Collection:

● Oct ‘06 to Jan ’07

● # THA patients = 70

● Confidence rating /10 = 2-10

● Average rating/10 = 8.74

PDSA Confidence : STUDY

Data Collection cont:

● # TKA patients = 97

● Confidence rating /10 = 5-10

● Average rating /10 = 8.74

PDSA Confidence : STUDY

Reasons for confidence less 8/10:

1. “I wanted to go to the Rehab Hospital”

2. “There is no one at home to care for me”

3. “I have no banister on my stairs”

4. “I am in the middle of renovations at home”

5. The “Unknown, nothing specific”

PDSA Confidence : DO

● All the reasons for decreased confidence related to lack of preparation prior to surgery.

● All staff, on POD #0, network with patient, friends, family and SW as needed to ensure a confident d/c on POD #3

PDSA LOS vs Standing: PLAN

What: Does standing POD #0 vs. POD #1 make a difference to LOS?

How: Each TJA was audited for LOS and first day standing to see if a trend appeared

PDSALOS vs Standing : DO

●Rehab staff will get patients up POD #0 as ordered by surgeons

● After hours (after 1700hrs), the float nurse will assist patients to standing


● Rehab staffing till 1700 hours was inconsistent due to unavailability

● Float nurse found herself frequently too busy with late admissions to the floor to stand patients.

● Some patients did not arrive on the floor till after 2000hrs

● Some patients’ orders “up POD #1

PDSALOS vs Standing : STUDY

●THA patients: 40 stood POD #0

27 stood POD #1

●Average LOS if stood POD #0 = 3.1

● Average LOS if stood POD #1= 4.2

PDSALOS vs Standing : STUDY

●TKA patients: 55 stood POD #0

41 stood POD #1

●Average LOS if stood POD #0 = 3.4

● Average LOS if stood POD #1 = 4.5

PDSALOS vs Standing : STUDY

●Statistics show a trend that LOS is shorter if stood POD #0

●HOWEVER, in checking reasons for NOT standing POD #0:

1. Increased co-morbidities

2. Longer stay in PAR (slower to floor)

3. Increased N &V and dizziness

● These patients tended to have more need for Rehab beds……longer LOS

PDSALOS vs Standing : STUDY

●The ability to stand POD #0 may not equate to shorter LOS but to a healthier Patient

●More review with fewer random influences needs to be made to see if standing POD #0 is best practice for shorter LOS


Background: 25% are from out-of-town


QuesnelParksvilleMaine Isl.


SandspitBella Bella Courtney

HagensborgBella CoolaP. Rupert

Nanoose B.Williams L.Kamloops

Nanimo Shawnigan L. Pemberton

PDSA Pre-op : PLAN

What: To enhance the preparedness of out-of-town patients for surgery

Why: Fail to attend pre-op class

Fail to obtain equipment

Unaware of the responsibilities & expectations

PDSA Pre-op: DO

Proposed Solution:

Education package includes:

1) "Quick Reference Guide"

●what equipment to obtain & where to get

● what to bring to hospital

● list of accommodations in Richmond area

● Richmond's inpatient rehab program

● LOS, discharge time & criteria

2) VCH Booklet

PDSA Pre-op: DO

Data Collection:

Interview prior to discharge:

1) Did you receive pre-op education?

When & Where?

2) Did you receive an "out-of-towners" package?

3) Did you obtain the recommended equipment?

4) Did you bring an appropriate walking aid?

5) What are your return travel plans?

6) “How confident are you with coping and managing at home on this discharge day?"

0 (not confident) to 10 (extremely confident)


Data Collection:

Mid Nov '06 - Mid Feb '07

THA n = 13

TKA n = 7

Total n = 20 out-of-towners

* 6 "repeat customers" excluded from study

* 6 unicompartmental knees excluded


4 Categories:

1) Package + Pre-op teaching

2)No Package + Pre-op teaching

3)Package + No Pre-op

4)No Package + No Pre-op


1) Package + Pre-op Teaching


2) No Package + Pre-op Teaching


3) Package + No Pre-op


4) No Package + No Pre-op



● Small sample size

Lesson Learned:

☺Importance of Pre-op class

Future Steps:

☺Earlier Pre-op booking

☺Satisfaction Questionnaire

Ortho Rehab Team

Bev (PT)

Ronda (PT)

Steph (OT)

Morag (OT)

Rachel (RA)

Ortho Nurses

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