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.
Bev Adamson (PT)
Stephanie Chung (OT)
What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital
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
●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.
● Oct ‘06 to Jan ’07
● # THA patients = 70
● Confidence rating /10 = 2-10
● Average rating/10 = 8.74
Data Collection cont:
● # TKA patients = 97
● Confidence rating /10 = 5-10
● Average rating /10 = 8.74
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”
● 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
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
●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
●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
●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
●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
●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
SandspitBella Bella Courtney
HagensborgBella CoolaP. Rupert
Nanoose B.Williams L.Kamloops
Nanimo Shawnigan L. Pemberton
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
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
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)
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
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
☺Importance of Pre-op class
☺Earlier Pre-op booking