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van Heusden-Scholtalbers L.1,2, Nouwens E.1,3, Dronkers J.4,5, Staal B.1,3, Engelbert R.6,7, Nijhuis-van der Sanden R.1
1Radboud University Medical Center - UMC, IQ Healthcare, Nijmegen, Netherlands, 2Radboud University Medical Center - UMC, Orthopedics, Physiotherapy, Nijmegen, Netherlands, 3HAN University of Applied Science Arnhem en Nijmegen, Nijmegen, Netherlands, 4Gelderse Vallei Hospital, Physiotherapy, Ede, Netherlands, 5University of Applied Science Utrecht, Utrecht, Netherlands, 6Academic Medical Center, University of Amsterdam, Rehabilitation, Amsterdam, Netherlands, 7Amsterdam University of Applied Sciences, Center of Applied Research, Faculty of Health, Amsterdam, Netherlands
Background: Quality indicators are used to monitor safety and quality of healthcare and to provide feedback to facilitate improvements. Despite physiotherapy being part of the overall standard care for major surgical patients, there is a great variety in physiotherapy clinical practice. Quality indicators are proposed to guide necessary quality improvements.
Purpose: In this study we focused on the use of quality indicators in the Plan-Do-Check-Act (PDCA) cycle to assess and improve current quality of perioperative physiotherapy care in patients undergoing abdominal or (cardio) thoracic surgery.
Methods: This is a before after study design. Nineteen physiotherapy departments of Dutch hospitals decided to participate in the study.
Firstly, using an online secured questionnaire, physiotherapy data from one month was sampled for 20 quality indicators (9 structure, 9 process and 3 outcome indicators) to assess current quality of perioperative physiotherapy care. Based on these baseline outcomes, improvement goals were formulated in each participating hospital. In the next step an implementation plan tailored to the local situation was developed and performed. The implementation was based on the seven phases of the implementation of change model from Grol and Wensing (2005). Participants were guided through these phases with personalized feedback on quality assessments, workshops, newsletters, an online private network to share knowledge and experiences with peers and coaching during the entire implementation of change. To evaluate, one year after baseline assessment, the quality indicators were used again to measure quality of perioperative physiotherapy care.
Results: All physiotherapy departments provided data for the quality assessments of perioperative physiotherapy in patients undergoing abdominal (19), thoracic (11), and cardiothoracic (9) surgery. To measure process indicators data from a total of 751 physiotherapy patient files was collected for baseline assessment and 636 files for the evaluative assessment. Participating departments could not provide sufficient information to measure the outcome indicators.
Improvements were observed on structure and process indicators. For the process indicators significant improvements were found on 19 indicators for abdominal surgery, 2 indicators for thoracic surgery and 4 indicators for cardiothoracic surgery. Most improvements were observed in indicators concerning availability and use of protocols and content of postoperative treatment. Participating departments set 110 improvement goals distributed over the three patient categories. Goal attainment was achieved in 61% of the indicators mentioned as specific improvement goals.
Conclusion(s): Quality assessment using quality indicators for physiotherapy care in patients undergoing abdominal and (cardio) thoracic surgery were adequate to integrate in a PDCA cycle. The hospital specific implementation strategy with tailored improvement goals and a multifaceted implementation approach with expert and peer guidance were effective in the group of 19 participating physiotherapy departments and led to improvements in quality of perioperative physiotherapy care. Although outcome indicators were determined for the quality indicators, no sufficient data was available to generate outcome indicator scores.
Implications: Integrating quality indicators into a PDCA Cycle and using a theory-based implementation strategy may be applicable to increase quality of physiotherapy care in other patient groups.
Funding acknowledgements: Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF) (Royal Dutch society of physiotherapy)/Nederlandse Vereniging voor Ziekenhuis Fysiotherapie (NVZF), participating physiotherapy departments.
Topic: Professional practice: other
Ethics approval: This study has been carried out in the Netherlands in accordance with the applicable rules concerning the research ethics committees.
All authors, affiliations and abstracts have been published as submitted.
