1. ACPRC Cardiothoracic Study Day Audit Of The Physiotherapy Service For Patients Undergoing Cardiac Surgery At Castle Hill Hospital Transferring Evidence into practice Nicola Beaumont Senior Physiotherapist Castle Hill Hospital, East Yorkshire March 2007

2. Objectives  To explore the evidence base and evaluate our own service provision against this  Professional networking  To implement change management in order to benchmark physiotherapy service provision against current available evidence

3. Aims  Increase the appropriate utilisation of physiotherapy services  Improve the patient and carer experience  A standardised physiotherapy service for patients undergoing cardiac surgery with a routine recovery, where treatments are evidence based, thus maximising quality and effectiveness for all concerned

4. Formally Registering the Audit  CG1 form - Recommendation to involve user groups Pt questionnaire developed Permission granted  Project Planning document

5. The Audit Process Plan Sample of 50 pt’s To collect baseline data Gather the evidence Evaluate the evidence Implement changes And re audit

6. Previous Service  Invitation to attend pre op information day  1POD treatment on ICU  Incentive spirometer  2POD and each day thereafter until discharge by the physiotherapist, actively assessing and treating chests, performing DBEx’s and mobilising patients  Stairs assessment where necessary for function prior to discharge  Discharge advice in the form of discharge booklet

7. Aspects evaluated  Value of routine DBEx’s and chest physiotherapy post op  The most recommended methods of mobilising in preparation for discharge, including stair climbing and pacing techniques  Whether patients were happy with the amount and type of treatment and discharge information they were receiving  The relative value of each aspect covered at the pre operative education talk

8. Finding the evidence Chest physiotherapy  Literature review  minimal evidence for the need for any active chest care in routine post op cardiac patients Mobilisation  Professional ‘consensus of opinion’  Interactive CSP website discussion forum

9. Implementing the evidence Chest physiotherapy  Withdraw post op chest care for routine patients from 2POD Mobilisation  Introduction of Borg scale  Pacing  Stair climbing

10. Descriptive Statistics Baseline Re Audit group  Number of pts 50 50  Average age of pts 65 yrs 71yrs (39-88 yrs) (49-89yrs)  Males3636  Females14 14

11. Results – Pre/ Post Implementation of New Physiotherapy service Baseline Re Audit group Mode number of days on treatment 4 days 4 days Mode length of stay in hospital 4 days 5 days Mode number of chest treatments 3 1 Mode number of mobility treatments 1 3 Number of patients who underwent 20% 64% formal stairs assessment

12. Results – Patients Perspective Pre operative education (VAS 1-10) BaselineRe Audit group Physiotherapy treatment 8 (4-10)8 (4-10) administered during stay Need for physiotherapy9 (8-10)9 (6-10) Management of pain 9 (8-10)9 (7-10) Discharge Information9(8-10)9(7-10) General Discharge advice9 (8-10)9 (8-10)

13. Satisfaction of number times seeing physiotherapist post op BaselineRe Audit group Yes 69%87% No 03% Too often 00 Not often enough 17%3% Not answered 14%7%

14. Any Aspects of Physiotherapy Patients not Satisfied with BaselineRe Audit group Yes6.5%0 No 76%97% Not sure3.5%0 Not answered14%3%

15. Received sufficient information regarding pacing Baseline Re Audit group Yes66%77% No14%6% Not answered20%13.5% Not sure03.5%

16. Did you have stairs to climb when you got home? BaselineRe Audit group Yes48%63% No34%27% Not answered18%10% Any problems encountered climbing stairs after discharge Baseline Re Audit group Yes11%16% No63%84%

17. Have you been referred to a cardiac rehabilitation programme BaselineRe Audit group Yes38%23.5% No55%73% Not answered7%3.5%

18. Further changes  Clinical effectiveness of Incentive Spirometers  Exercise diaries for patients  Further investigation into the value/intensity of circulatory exercises is recommended

19. Contact details  Nicola.beaumont@hey.nhs.uk Nicola.beaumont@hey.nhs.uk  Jayne.anderson@hey.nhs.uk Jayne.anderson@hey.nhs.uk  Susannah.wright@hey.nhs.uk  Physiotherapy department  Castle Hill Hospital Castle Road Cottingham East Yorkshire HU16 5JQ