Delivery of eQIPP through a seven day working physiotherapy service for cardio-thoracic surgery patients South Tees Hospitals NHS Foundation Trust Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013 More information about this event can be found at http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx

1. DELIVERING eQIPP THROUGH 7-DAY
WORKING PHYSIOTHERAPY SERVICE FOR
CARDIO-THORACIC SURGERY PATIENTS
SCTS
Society for
Cardiothoracic
Surgery in
Great Britain
& Ireland
Contact: bparadza@nhs.net
RESULTS
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.
Table 1: Patient Satisfaction Survey 2011
Questionnaires, sample n=113,
completed n=111, uncompleted n=2
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].
BETTER
Overall
satisfaction
AIMS & OBJECTIVES
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
METHODS
Re-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.
Neither
satisfied nor
dissatisfied
Dissatisfied
Very
dissatisfied
95 (85%)
14 (13%)
2 (2%)
-
-
98%
BACKGROUND
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].
Satisfied
N (%)
Physiotherapy intervention is widely prescribed for patients
to facilitate early recovery and timely discharges[2-5].
Very
satisfied
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)
BETTER
QUALITY
PRODUCTIVITY
OUTCOMES
“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
Allow
for flexible
working culture.
Flexitime, shift
swapping, self
rostering is
superb.
BETTER
FOR STAFF
Figure 3: 6.74%
The
staff are
happy to do
weekends!
No
parking
problems,
we miss the
rush hour!
(N=81) increase in
patient throughput or patient flow
through the system
Decreased
LOS ... means
less ‘hotel’
costs!
We
are more
effective and
productive,
especially over
weekends!
We’re
enjoying
a better
shift work
lifestyle.
Improved
‘quality of
care’ ... we’re
saving lives!
N=1361 patients
SUMMARY (OF EFFICIENCY SAVINGS)
Figure 4:
Weekday vs
weekend
effect
Significant
difference
5-day week
versus 7-day
week service
(p<0.05).
Supported
timely, early
discharges.
• 7-day week service reduced group median
LOS from 6.93 to 5.91 days, p< 0.03 increased
patient discharges by 6.74%!
• 426 bed-days savings achieved in 1 year.
• £156,232 estimated cost savings achieved on
706 CABG patients in 1 year.
• On-call emergency services replaced saving
£24.096 a year.
• £ 22,464 staff enhancement costs for 6
therapists a year.
• CMA - estimated £157,864 in efficiency saving
to the system over 12 months.
• No changes in mortality rates (1.7 vs 2.1%) or
outliers (36 vs 39).
CONCLUSION
7-DW Service safely reduced LOS, delivers
quality and productivity whilst contributing
to efficiency savings AND staff experience
and patients satisfaction ratings were high.
Figure 1:
Audits
1, 2 & 3
REFERENCES:
Figure 5:
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.
MICB4385
INTRODUCTION
Mr Brighton Paradza
Senior specialist physiotherapist
The James Cook University Hospital