1. Richmond Hospital PDSA Presented by: Bev Adamson (PT)
Stephanie Chung (OT)

2. PDSA Confidence: PLAN
What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital

3. 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

4. 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.

5. PDSA Confidence : STUDY
Data Collection:
● Oct ‘06 to Jan ’07
● # THA patients = 70
● Confidence rating /10 = 2-10
● Average rating/10 = 8.74

6. PDSA Confidence : STUDY
Data Collection cont:
● # TKA patients = 97
● Confidence rating /10 = 5-10
● Average rating /10 = 8.74

7. 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”

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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)

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. PDSA Pre-op: ACTION Limitations: ● Small sample size Lesson Learned:
☺Importance of Pre-op class
Future Steps:
☺Earlier Pre-op booking
☺Satisfaction Questionnaire

27. Ortho Rehab Team
Bev (PT)
Ronda (PT)
Steph (OT)
Morag (OT)
Rachel (RA)

28. Ortho Nurses