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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
PDSA Confidence: PLAN

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

Pdsa confidence plan1
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
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
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 study1
PDSA Confidence : STUDY

Data Collection cont:

● # TKA patients = 97

● Confidence rating /10 = 5-10

● Average rating /10 = 8.74

Pdsa confidence study2
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 do1
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
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

Pdsa los vs standing do
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

Pdsa los vs standing study

● 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

Pdsa los vs standing study1
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

Pdsa los vs standing study2
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

Pdsa los vs standing study3
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

Pdsa los vs standing study4
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

Pdsa pre op plan

Background: 25% are from out-of-town


Quesnel Parksville Maine Isl.

Massett Sayward Victoria

Sandspit Bella Bella Courtney

Hagensborg Bella Coola P. Rupert

Nanoose B. Williams L. Kamloops

Nanimo Shawnigan L. Pemberton

Pdsa pre op plan1
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
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 do1
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)

Pdsa pre op study

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

Pdsa pre op study1

4 Categories:

1) Package + Pre-op teaching

2) No Package + Pre-op teaching

3) Package + No Pre-op

4) No Package + No Pre-op

Pdsa pre op study2

1) Package + Pre-op Teaching

Pdsa pre op study3

2) No Package + Pre-op Teaching

Pdsa pre op study4

3) Package + No Pre-op

Pdsa pre op study5

4) No Package + No Pre-op

Pdsa pre op action


● Small sample size

Lesson Learned:

☺Importance of Pre-op class

Future Steps:

☺Earlier Pre-op booking

☺Satisfaction Questionnaire

Ortho rehab team
Ortho Rehab Team

Bev (PT)

Ronda (PT)

Steph (OT)

Morag (OT)

Rachel (RA)