Ms Ruchika Rawat1, Mr Christopher Lindner
1Barwon Health, Geelong, Australia
Despite knowledge about interventions that are effective in reducing re-admission rates and length of stay and increasing patient satisfaction outcomes, significant difficulties remain in improving care integration and users’ experiences of discharge. At McKellar Centre (MCK), the physiotherapy discharge process was observed to be fragmented with inadequate patient engagement and communication.
Is the variation in Physiotherapy discharge processes impacting patient and staff satisfaction and influencing the length of stay in the subacute inpatients at Mc Kellar Centre?
A mixed method approach of quantitative and qualitative research methodologies was used after approval from Barwon Health Research Ethics, Governance & Integrity (REGI) Unit. Patient and staff satisfaction surveys, systems data capture such as frequency of delay in discharge in the last seven days of Expected date of Discharge (EDD), total average Length of stay added due to delay, audit of past Victorian Health Experience Survey (VHES) for feedback on discharge processes, audit of Australasian Faculty of Rehabilitation Medicine (AROC) Functional Independence Measures (FIM), Individual Patient Attributed (IPA) time entered into weekly statistics by physiotherapists over the last week prior to discharge and a Root Cause Analysis (RCA)
- Voice of patients
- 47% reported enough opportunity to discuss discharge
- 58% reported they didn’t receive information regarding post-discharge follow-up
- Number of times discharge was delayed within one week of EDD (Physiotherapy reasons) = 12 per month
- Increase in length of stay 83.5 days per month
- Staff feedback- Discharge is rushed at times and there is scope for improvement.
The variation in Physiotherapy discharge processes impacts patient and staff satisfaction and influences the length of stay in the subacute inpatients at MCK..
There is significant potential to improve physiotherapy discharge planning and communication for best patient care. ‘Countdown to discharge’ started at MCK.
Clinician-Researcher in the Spotlight:
Excerpt from my book ‘More than a Mum’- “My story starts in India, being born and brought up there, living a content life, in my own little bundle of happy existence. A well-established physiotherapist working for the Ministry of Health and Family Welfare, married to a successful ICT professional, working with an MNC, my life was headed exactly where I wanted. To add to this, our little bundle of joy- our daughter- arrived soon after. Life was good, and even though my husband had asked me about emigration a few times, I had never been interested. I didn’t even give it any thought, until that one day, that one incident that shook my country to its core- the Nirbhaya gang rape case, a physiotherapy intern gang raped and tortured mercilessly in the heart of the capital city. Suddenly my land didn’t feel safe anymore. Suddenly, the foundations that held me to my country- the security that cocooned me- were broken in one big blow. The new mother in me couldn’t fathom that the city that I grew up in was now so unsafe. That’s when we decided to immigrate to Australia.
Come 1st of January 2015, we reached Melbourne airport, and the memory is still fresh in my mind! How can I ever forget the words of the officer at Arrivals who flipping the pages of my passport, asked, “Hey lady, Are you here for good?” I smiled and replied, “Yes, officer! For sure!” He responded with, “Welcome home”. Wow! Nothing has inspired me or assuaged me like those two words, be it the lowest low or a highest high; Australia is and always will be home. Australia is an astounding place – so very uniquely multicultural; like a cosmopolitan embrace.”
Starting from scratch in a new country is not easy. However, I am proud of my journey; enjoying, learning and ever-evolving. Before joining Barwon Health in Nov 2017; I served as a member of Community Voice Panel for Maribyrnong City Council and ventured into entrepreneurship as Founder and Owner of ‘Roo and Joey’. The Women’s Business School, Australia started a new category of Multicultural Award after myself becoming the Sustainability Award finalist. I am honoured and inspired to be part of the team and judging panel of the AusMumprenuer Awards every year. I strongly advocate the cause of Gender equality and financial freedom for females and am involved in promotion and awareness as a member of the United Nations Women National Committee. I also manage a non- profit organisation; Community Aid Australia Inc. for empowering multicultural communities and guiding the shared vision and culture of the collective as an inclusive, supportive and innovative group. Previously I have worked as Community Researcher with Alcohol and Drug Foundation, Melbourne. I am also involved in Federal Government’s project- Be Connected; Digital literacy for every Australian.
My journey at Barwon Health has been amazing. The very first week I joined the Inpatient Rehabilitation Department; the inquisitiveness in me questioned the use of fabric chairs in the Inpatient gym. I was considered a fresh pair of eyes for ‘things which had always been like this’. My queries from ‘infection control for fabric chairs in high usage areas like inpatient gyms’ to ‘proposal to develop exercise sheets for NESB inpatients’ to ‘posting of gait aid traffic light system poster in each patient room’ were very warmly welcomed in the South Physiotherapy team.
I have been fortunate that my enthusiasm for trying new things even in the tiniest grass- root level to bigger ideas was supported by Barwon Health. At the BH Supervision Essentials workshop, I audited a Victorian Health Experience Survey (VHES) survey result data which indicated fragmented discharge processes with inadequate patient engagement and communication. This intrigued me further to explore current physiotherapy discharge planning and processes in the inpatient ward.
Around the same time, I learnt about scholarship to Barwon Health staff to pursue ‘Graduate Certificate in Clinical Redesign.’ Ms Annabel Gill, Physiotherapist encouraged me to pursue it. This course has furthered my confidence in learning new skills and knowledge and gripping myself with the tools of Clinical Redesign- Change management frameworks, Diagnostics and Analysis of service delivery blocks, quality and safety issues, Health Service Innovation, EBCD models, Research designs, and critically appraise published research in order to design future research projects, and make evidence based decisions to improve practice in clinical settings. Mr Ross Piper, Hydrotherapy Leader also pursued the course with me and both of us supported each other through various study units. Barwon Health supported us with Master class day, study leave provision, PMO and REGI.
With the incredible support and guidance of Mr Chris Lindner, Physiotherapy Manager, Dr Olivia King, Allied Health Research and Translation Lead, and Mr Raymond James, Senior Physiotherapist- Ortho & Amputee, I have been able to recently complete a research project as the Principal Research Investigator regarding impact of physiotherapy discharge planning and processes on patient and staff satisfaction at Mc Kellar Centre, a subacute Barwon Health site. This research identified some gaps and emerging themes and led to a quality improvement project; Countdown to discharge – A Physiotherapy Intervention. This research study was presented at the Barwon Health- Deakin University Research Webinar series 2020 and the resulting QI project will be presented on Monash AHA Day 2020.
I am truly grateful for my journey at Barwon Health and the support for my interest in Research and innovation for better and safer quality care. As Mahatma Gandhi rightly once said, “I am the change I want to see in the world”. Also, I truly believe in the quote by William Jennings Bryan: “Destiny is not a matter of Chance. It is a matter of Choice.”
I am glad to be working at such a supportive work place. Thank you Barwon Health for the wonderful journey