MIC

B43

85

DELIVERING eQIPP THROUGH 7-DAY WORKING PHYSIOTHERAPY SERVICE FOR CARDIO-THORACIC SURGERY PATIENTS

Mr Brighton Paradza Senior specialist physiotherapist

The James Cook University Hospital

INTRODUCTION RESULTS

BACKGROUND

AIMS & OBJECTIVES

Traditionally physiotherapists provided a routine 5-day service from Monday to Friday, creating ‘Service-Gaps’ from limited emergency services at weekends and bank holidays only.

The purpose of this service Improvement effort was to re-design, implement, monitor and evaluate the impact of a 7-day working model on healthcare outcomes (hospitalisation, efficiency cost savings, staff and patients satisfaction ratings)[1,2, & 6].

Physiotherapy intervention is widely prescribed for patients to facilitate early recovery and timely discharges[2-5].

Service delivery lacks uniformity[3,4] and there is worldwide variation in physiotherapy provision across many centres and healthcare systems. At our centre, care provision gaps existed between weekends versus weekdays due to lack of a standardised cardiac rehabilitation strategy accessible 24/7, 365 days a year[6].

Aim: To identify the benefits, cost-effectiveness and impact on health outcomes of delivering 7-day physiotherapy services within secondary care pathways.

Diagram 1: Project Objectives

HEALTH SYSTEM

STAFF

PATIENTS

Structure

Processes

Outcomes

Value for money

Reliable, better work - life balance

Safe, decent experience

METHODSRe-design Phase: 3 cycles of audits were conducted between January and September 2006 (fig 1) involving 582 patients (n) and 6 therapists.

The primary outcome LOS was benchmarked at 7 and 14 days as per protocol (see fig 2).

Evaluative Phase: A retrospective study using pre and post intervention data from 1361 CABG patients (see figs 3-5), patient satisfaction survey ratings (see table 1) and staff feedback (see diagram 2). *Comparative descriptive statistics, regression and cost minimisation analysis (CMA) determined changes in LOS over 24 months between April 2005-2007, post-CABG at 80% power and level of 0.05.

Figure 2: LOS showed a reduction by 2-bed days

Primary Outcome: mean LOS 7.47±3.36days [CI:7.21-7.72](Group Median=6.53) 6.93± 3.22days [CI:6.70-7.17] (Group Median=5.91)

Figure 1: Audits

1, 2 & 3

BETTER QUALITY

PRODUCTIVITY OUTCOMES

Figure 3: 6.74%

(N=81) increase in patient through-put or patient flow through the system

N=1361 patients

Figure 4: Weekday vs weekend effect

Significant difference 5-day week versus 7-day week service (p<0.05). Supported timely, early discharges.

Figure 5:

“I was told this was the best hospital and it is.”“Tough when they had to be ... I found the exercises of

immediate benefit and I saw clear evidence of the process being applied in a manner that reflected the patients need i.e.

not a one size fits all approach.”“I’m impressed by the quality of written information - it’s been

very useful”“The physiotherapy service is vital for patients recovering from

major surgery and I think it is excellent.”“Very helpful after the operation, no complaints about

anything, everything was superb, thank you very much.”

Diagram 2: Staff experience and feedback

Overall satisfaction

N (%)

98%Very satisfied

95 (85%)

Satisfied

14 (13%)

Neither satisfied nor dissatisfied

2 (2%)

Dissatisfied

-

Very dissatisfied

-

SUMMARY (OF EFFICIENCY SAVINGS)

CONCLUSION

• 7-dayweekservicereducedgroupmedianLOS from 6.93 to 5.91 days, p< 0.03 increased patient discharges by 6.74%!

• 426bed-dayssavingsachievedin1year.• £156,232estimatedcostsavingsachievedon

706 CABG patients in 1 year.• On-callemergencyservicesreplacedsaving£24.096ayear.

• £22,464staffenhancementcostsfor6therapists a year.

• CMA-estimated£157,864inefficiencysavingto the system over 12 months.

• Nochangesinmortalityrates(1.7vs2.1%)oroutliers (36 vs 39).

7-DW Service safely reduced LOS, delivers quality and productivity whilst contributing to efficiency savings AND staff experience and patients satisfaction ratings were high.

REFERENCES:1] Department of Health (2010) The NHS: Quality, Innovation, Productivity and Prevention Challenge: an introduction for clinicians. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113806[2] Brusco N K, Paratz J. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: A systematic review. Physiotherapy Theory and Practice 2006; 22(6):296-307.[3] Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised Moderate Intensity Improves Distance Walked at Hospital Discharge Following Coronary Artery Bypass Graft Surgery- A Randomised Controlled Trial. Heart, Lung and Circulation 2008;17:129-138.[4] Westerdalh E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep-Breathing Exercises Reduce Atelectasis and Improve Pulmonary Function After Coronary Artery Bypass Surgery. Chest 2005;128:3482-8.[5] Wynne R, Botti M. Postoperative Pulmonary Dysfunction in Adults after Cardiac Surgery with Cardiopulmonary Bypass: Clinical Significance and Implications for Practice. American Journal of Critical Care. 2004;13(5):384-93[6] Curry A, Sinclair E. 92002) Assessing the Quality of Physiotherapy services using the Servqual. International Journal of Health Care Quality: 15(5); 197205.

Allow for flexible

working culture. Flexitime, shift swapping, self

rostering is superb.

No parking

problems, we miss the rush hour!

Decreased LOS ... means

less ‘hotel’ costs!

We’re enjoying a better

shift work lifestyle.

The staff are

happy to do weekends!

Improved ‘quality of

care’ ... we’re saving lives!

We are more

effective and productive,

especially over weekends!

BETTER

Table 1: Patient Satisfaction Survey 2011 Questionnaires, sample n=113, completed n=111, uncompleted n=2

BETTER FOR STAFF

Contact: bparadza@nhs.net

SCTSSociety for

Cardiothoracic Surgery in

Great Britain & Ireland