Page 121 - HA Convention 2016 [Full Version]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F1.2 Service Revamp 13:15 Room 421

Integrating Rehabilitation into the Heart of Acute Care — Ward-based Physiotherapy at C8 Elderly-friendly Ward

Increases Therapy Time and Team Collaboration
Chan F 1,Tao K 1, Chan C 1, Ng F 2, Ho J 2, Kng C 2
1Department of Physiotherapy, 2Department of Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

Introduction

Safe and early mobilisation, fall prevention and functional independence are essential components in acute care of the elderly.
C8 acute geriatric ward incorporated a specially-designed multifunctional day area equipped with rehabilitation equipment,
enables ward-based physiotherapy (PT) that engages major key stakeholders. A systematic PT mobility assessment and
fall prevention algorithm was developed to ensure that patients in need were recruited for the ward-based early mobilisation
and fall prevention PT programme in additional to the traditional bed-side PT care. Besides, safe and early mobilisation was
advocated in the evening and during weekend, through the active engagement of committed nurses and caregivers.

Objective
To evaluate clinical benefits and efficiency of the ward-based PT programme.

Methodology Tuesday, 3 May

C8 patients screened or referred for in-patient PT from July to December 2015 were recruited. Cross-sectional study was
conducted to examine patients’ demographics and physical performance. Process indicators on patient attendance, PT time,
transportation time and staff man-hours were analysed. Besides, satisfaction survey was conducted to collect feedback from
patients and nurses.

Results

680 patients (62%) of 1,098 admissions in C8 ward were recruited to the ward-based PT programme. 103 of them (mean
age=81.1±6.4; 9.4% of C8 admissions) were identified through the PT Fall Prevention Algorithm. Ward-based PT training
session lasted for 75 minutes in the morning and 35 minutes in the afternoon. Also, patients, caregivers and nurses were
engaged in evening and weekend exercise training sessions (20 minutes daily). Three times more acute patients benefited
from the PT early mobilisation programme sooner, with 5.5 times increase in PT duration (i.e. 130 vs 20 minutes per patient
per day when comparing ward-based PT in C8 and gym-based PT in comparative acute geriatric ward respectively).
Rehabilitating patients in the well-equipped C8 multifunctional day area not only helped to save 1.7 supporting man-hours/
day in porterage but also enabled longer PT session with better exercise tolerance in patients. Ward-based PT programme
was well accepted by key stakeholders; the overall satisfaction of both patients and nurses were 87.5±6.8% and 84.3±9.8%
respectively.

Conclusion

Two-thirds of acute elderly patients receiving ward-based PT as part of comprehensive multidisciplinary elderly-friendly
care benefitted from safe and early mobilisation and increased PT duration. In addition, the enhanced multidisciplinary
collaboration and increased care-giver engagement resulted in satisfaction of both patients and nurses.

119