Integrated Model for Unilateral Knee Replacement Patients Jacqueline

Integrated Model for Unilateral Knee Replacement Patients Jacqueline Minezes, Jennifer Santos, Joanna Armatys, and Melanie Di Carlo Central West Local Health Integration Network & William Osler Health System Measures Outcome – Number of patients attending both H&CC and Outpatient Physiotherapy Process – Number of unique patients seen in EGH Outpatient Physiotherapy weekly; number of patients in the NEMWW sub-region receiving H&CC following TKR at Osler Balancing – Patient satisfaction; wait time between discharge from acute care and first Outpatient Physiotherapy visit 20 18 16 14 12 10 8 6 4 2 0 Apr P 1 Apr P 2 Apr P 3 Apr P 4 Apr P 5 Apr May May P 6 P 1 P 2 P 3 P 4 P 5 P 6 P 7 P 8 Patient Number of Outpatient Physiotherapy Visits 20 18 14 12 10 8 6 BCH 2 0 Apr P 1 Apr P 2 Apr P 3 Apr P 4 Apr P 5 Apr P 6 May May P 1 P 2 P 3 P 4 P 5 P 6 P 7 P 8 Patient Discharge disposition rationale to H&CC- PDSA learnings By March 31, 2019, there will be a 25% decrease in TKR patients (residing within the NEMWW sub-region) receiving both H&CC and Outpatient Physiotherapy at EGH 14% Lack of Transportation No Capacity 43% 21% Distance too far Contributions to Success: • Support from Executive Sponsors • Stakeholder engagement • Opportunity to innovate • Coaching from QI advisor Results During IDEAS • Increased collaboration between Osler and Central West LHIN H&CC • Co-design of Standardized Eligibility Criteria and ‘Passport to Rehabilitation’ • Increased awareness of patients’ rehabilitation journey from a system level • Engagement with front-line physiotherapists • Patient focus group validated current state diagnostics Charts Total Number of TKR Physiotherapy Visits (Home & Community Care + Etobicoke General Hospital Outpatient) 24 Total Number of PT Visits 20 UCL 22. 2 CL 19. 5 LCL 16. 8 18 16 Challenges: • Data sharing between organizations • Cross-sectoral decision making • Absence of pre-hab • Decision to increase outpatient capacity • Timeline to develop and solidify community partnerships Sustainability • Formal governance and accountability structure for Bundled Care in place • Standardized application of eligibility criteria in acute care • Implement the ‘Passport to Rehabilitation’ • Continue to test the change Ideas • Collaboration with surgeons • Stakeholder engagement and collaboration across the care continuum Driver Diagram 22 Organizational Enablers Other 21% Diagnostics increased capacity in EGH outpatient knee classes 14 12 10 Apr P 1 Apr P 2 Apr P 3 Apr P 4 Apr P 5 Apr P 6 May P 1 May P 2 May P 3 Unique Patient & Month May P 4 May P 5 May P 6 Spread May P 7 Spread of the interventions and change ideas has not yet taken place within the Central West LHIN, however we will consider opportunities to roll-out within other sub-regions including: Brampton, Caledon and Dufferin County. Intervention/Change Ideas Wait Time from Hospital Discharge to Outpatient Physiotherapy 120 100 Wait Time (# of days) • Standardize eligibility criteria for H&CC and/or Outpatient Physiotherapy • Introduce a Rehabilitation Care Coordinator • Develop ‘Passport to Rehabilitation’ • Explore partnerships in a community location • Engage patients and families EGH 16 4 PDSA Learnings Aim Statement Number of Visits Patients who undergo an elective unilateral total knee replacement (TKR) at Brampton Civic Hospital (BCH), and who reside in the North Etobicoke Malton West Woodbridge (NEMWW) sub-region, receive both home and community care (H&CC) and outpatient physiotherapy at the Etobicoke General Hospital (EGH) site. The combined total number of physiotherapy visits is approximately 20, which exceeds best practice recommendations. Number of Home & Community Care Physiotherapy Visits Number of Visits Problem Statement UCL 100. 2 Patient referred 6 weeks post-operative 80 67. 2 60 CL 46. 5 46. 3 40 25. 4 20 0 -20 Apr P 1 LCL Apr P 2 -7. 2 Apr P 3 Apr P 4 Apr P 5 -7. 2 Apr P 6 May P 1 May P 2 May P 3 Unique Patient & Month May P 4 May P 5 May P 6 May P 7 May P 8 Lessons Learned • Stakeholder representation at meetings • Risk assessment when pursuing external partnerships • Monitor unintended consequences with other services in Outpatient Physiotherapy • Importance of Inter-Professional Collaboration across Sectors • Need for dedicated frontline resources Next Steps • Implement the Sustainability plan • Implement a Visual Management System • Implement an Evaluation Plan Contact Name: Jacqueline Minezes Title: Manager, Home & Community Care and Rehabilitation Services Organization: Central West LHIN Email: Jacqueline. Minezes@lhins. on. ca Phone: 1 -888 -733 -1177, ext. 7260