Back to accessibility links

Don’t Restrict My Ability: Improving Care and Communication for Restricted Weight Bearing Patients

Concord Repatriation General Hospital
Project Added:
27 November 2015
Last updated:
3 December 2015

Don’t Restrict My Ability: Improving Care and Communication for Restricted Weight Bearing Patients

Summary 

This project aimed to improve the patient flow of restricted weight bearing (RWB) patients through the acute orthopaedic service, by implementing a reconditioning program that optimised recovery following surgery. Communication processes were also incorporated into the model of care, to keep patients informed and improve their experience.

View a poster of this project from the Centre for Healthcare Redesign graduation, December 2015.

Don't restrict my ability poster

Aim

To reduce the length of stay (LoS) of RWB orthopaedic patients from six weeks to two weeks by July 2016 and improve the patient experience of this cohort by 30% by July 2016.

Benefits

  • Improves health outcomes and reduces LoS in acute settings for RWB patients.
  • Improves the patient and carer experience.
  • Provides cost savings and maximises use of acute and subacute services, so patients are cared for in the right place at the right time with the right support.
  • Supports the clinical pathway through a documented model of care.
  • Improves teamwork due to strengthened communication processes and common understanding of care processes.

Project Status

Project status: Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

  • Project start: March 2015
  • Project finish: July 2016

Background

An ongoing barrier to timely discharge at Concord Repatriation General Hospital is the number of RWB patients in the orthopaedic unit. RWB is when patients are limited by the amount of weight they are allowed to place on their affected limb.

In 2013-14, 156 patients were RWB and experienced an extended LoS due to their inability to safely mobilise. This resulted in 4686 beds that were occupied and a cost of $4,686,000 to the healthcare system. It also led to a loss of six acute orthopaedic beds.

The inability to safely mobilise these patients also results in barriers to returning home, as they do not meet the admission criteria for rehabilitation or transitional care units.

Implementation

  • Standardised the approach to documenting RWB progress in the patient notes.
  • Improved communication processes, through family conferences, brochures and a consensus from the surgeons regarding the definition of an RWB patient.
  • Enhanced the patient experience through the development of a reconditioning program to optimise function and recovery, a daily acute exercise program and a patient calendar with recovery goals.
  • Delays to discharge were addressed, including the allocation of four subacute orthopaedic beds and early referrals to transitional care.
  • LoS was reduced by nine days between March and November 2015, resulting in an average LoS of 22 days.
  • The reconditioning program has resulted in improvements to function and mobility, as well as improved Functional Improvement Measure scores.
  • Patient experience increased to 80%, as measured by patient experience trackers and surveys.
  • 100% staff compliance with RWB postoperative documentation was achieved by November 2015.
  • There is improved flow through the orthopaedic unit, as demonstrated by the reduced LoS.

Implementation site

Orthopaedic Unit, Concord Repatriation General Hospital 

Partnership

Clinical Excellence Commission Clinical Leadership Program

Lessons Learnt

  • The support of sponsors, involvement of key stakeholders and clinical engagement from the commencement of the project is crucial to its success and sustainability.
  • Accessibility of accurate and complete data is crucial for making informed decisions and presenting the case for change.
  • Presenting patient stories and experience gives projects meaning and relevance.

Further Reading

  • Hustedt J, Blizzard D, Baumgaertner MR et al. Current advances in training orthopaedic patients to comply with partial weight-bearing instructions. Journal of Biological Medicine 2012; 85(1): 119-125.
  • Yu S, McDonald T, Jesudason C et al. Orthopaedic inpatients’ ability to accurately reproduce partial weight-bearing orders. Healio Orthopaedics 2014; 37(1): 10-18.
  • Gills A, MacDonald B. Prevention deconditioning in the hospitalized elderly. The Canadian Nurse 2005; 101(6): 15-20.

Contacts

Megan White
Clinical Nurse Coordinator
Orthopaedic Unit, Concord Hospital
Sydney Local Health District
Phone: 02 9767 5325
megan.white@sswahs.nsw.gov.au

Breda Doyle
Manager, Clinical Governance
Concord Hospital
Sydney Local Health District
Phone: 02 9767 7095
breda.doyle@sswahs.nsw.gov.au

Search Projects

Browse Projects

Submit your local innovation
and improvement project