Richmond Hospital PDSA 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

PDSA LOS 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 : 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 : 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 : 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 : 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 Locations: 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 : 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)

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: STUDY 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: STUDY 1) Package + Pre-op Teaching TKA LOS: 3 Confid: 8 Well prepared THA 3 10 4 8 5 Low BP delayed discharge. Well prepared. Low O2 delayed discharge. Well prepared. 9 Waited for HFH 7 Nausea + vomiting delayed discharge. Well prepared N= 9 Ave: 4.4 Ave: 9.3

PDSA Pre-op: STUDY 2) No Package + Pre-op Teaching TKA LOS: 3 Confid: 9 Well prepared 3 10 THA 9 4 6 Blood Transfusion. ↓ confidence due to fear of the unknown. Attended pre-op the day before surgery. No equip. Purchased crutches from ward. 5 8 Attended pre-op the day before surgery. No equipment. Nausea++ N= 7 Ave: 3.5 Ave: 8.7

PDSA Pre-op: STUDY 3) Package + No Pre-op TKA LOS: 5 Confid: 6 THA 4 9 Did not read package. Did not arrange travel plans. Purchased crutches from ward. ↓ confidence due to lack of help. THA 4 9 Obtained equipment. Prepared. N=2 Ave: 4.5 Ave: 7.5

PDSA Pre-op: STUDY 4) No Package + No Pre-op TKA LOS: 3 Confid: 6 THA Supportive family-obtained equipment & made travel plans by discharge. ↓ confidence due to fear of the unknown. THA 3 8 N= 2 Ave: 3 Ave: 7

PDSA Pre-op: ACTION Limitations: ● 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