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Christie HJ1, Dickson K1, Johnson K1, Eng W1, McIntyre F1
1St. Boniface Hospital, Rehabilitation Services, Winnipeg, Canada
Background: As part of a regional initiative, the patient population at our tertiary hospital changed from one spanning the continuum of care to acute care only. As a result, patient turnover was faster, patients were less stable, and treatment plans changed quickly and often.
Purpose: This paper outlines three physiotherapy department initiatives undertaken to address these changes. Daily huddles were instituted to facilitate communication, our prioritization system was modified to reflect the new population, and staff was redeployed to different treatment locations to optimize treatment options.
Methods: A Plan-Do-Study-Act (PDSA) approach was used to implement and evaluate these initiatives. Daily huddles were trialed using formal and informal formats as well as small and large groups. Focus groups were used to develop a new prioritization system which recognizes the acuity of patients and frequent fluctuation. Resources were shifted from unit-based physiotherapists to other models of staffing to allow for treatment of specific patients in a physiotherapy gym setting with access to additional equipment without requiring displacement of the therapist from the unit for extended periods of time.
Results: The most effective daily huddle format was found to be informal, small group huddles at the beginning of the day with a formal, large group huddle at mid-day. Therapist to therapist communication improved, therapist stress levels improved anecdotally, and issue management was facilitated. A two-level system of patient prioritization was successfully rolled out. Therapists found the new system clearer and easier to use with the new populations thus facilitating between therapist communication and upward communication within the hospital. A model of unit-based intervention with a supplemental, dedicated ´gym therapist´ was adopted to facilitate expanded treatment options using various forms of physiotherapy equipment for longer stay patients. This position retained therapist efficiency by eliminating lost time traveling between the patient care unit and the gym and the therapist did not need to balance scheduled and unscheduled patient care. Patients are receiving more care without an increase in resource utilization by increasing efficiency. Limitations related to patient acuity and infection control have been resolved as well as possible within our ability.
Conclusion(s): Adapting to change is never easy. These initiatives have allowed for improved communication, decreased therapist stress and improved treatment efficiency in a new environment for this physiotherapy department. Several barriers were overcome during the PDSA process. Despite success with these initiatives, we continue to evaluate processes due to continuous changes to the regional structure.
Implications: Changing the framework of patient care delivery can improve the therapist and patient experience in an acute care facility which changed its focus from full spectrum to acute care.
Keywords: Acute care services, Communication, Facilitating flow
Funding acknowledgements: This was unfunded work done within the scope of the normal quality initiative process of the facility.
Purpose: This paper outlines three physiotherapy department initiatives undertaken to address these changes. Daily huddles were instituted to facilitate communication, our prioritization system was modified to reflect the new population, and staff was redeployed to different treatment locations to optimize treatment options.
Methods: A Plan-Do-Study-Act (PDSA) approach was used to implement and evaluate these initiatives. Daily huddles were trialed using formal and informal formats as well as small and large groups. Focus groups were used to develop a new prioritization system which recognizes the acuity of patients and frequent fluctuation. Resources were shifted from unit-based physiotherapists to other models of staffing to allow for treatment of specific patients in a physiotherapy gym setting with access to additional equipment without requiring displacement of the therapist from the unit for extended periods of time.
Results: The most effective daily huddle format was found to be informal, small group huddles at the beginning of the day with a formal, large group huddle at mid-day. Therapist to therapist communication improved, therapist stress levels improved anecdotally, and issue management was facilitated. A two-level system of patient prioritization was successfully rolled out. Therapists found the new system clearer and easier to use with the new populations thus facilitating between therapist communication and upward communication within the hospital. A model of unit-based intervention with a supplemental, dedicated ´gym therapist´ was adopted to facilitate expanded treatment options using various forms of physiotherapy equipment for longer stay patients. This position retained therapist efficiency by eliminating lost time traveling between the patient care unit and the gym and the therapist did not need to balance scheduled and unscheduled patient care. Patients are receiving more care without an increase in resource utilization by increasing efficiency. Limitations related to patient acuity and infection control have been resolved as well as possible within our ability.
Conclusion(s): Adapting to change is never easy. These initiatives have allowed for improved communication, decreased therapist stress and improved treatment efficiency in a new environment for this physiotherapy department. Several barriers were overcome during the PDSA process. Despite success with these initiatives, we continue to evaluate processes due to continuous changes to the regional structure.
Implications: Changing the framework of patient care delivery can improve the therapist and patient experience in an acute care facility which changed its focus from full spectrum to acute care.
Keywords: Acute care services, Communication, Facilitating flow
Funding acknowledgements: This was unfunded work done within the scope of the normal quality initiative process of the facility.
Topic: Professional practice: other
Ethics approval required: No
Institution: St. Boniface Hospital
Ethics committee: Research Review Committee
Reason not required: In consultation, these projects were considered program evaluation and did not require review.
All authors, affiliations and abstracts have been published as submitted.
