Priming for Patients: Improving rapidly

Nathan Liewicki
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Alexis Kindrachuk, a physical therapist with the Five Hills Health Region, conducts an examination on Doreen Jerred at the Moose Jaw Union Hospital on Feb. 6. Both women were involved in one of three Rapid Process Improvement Week groups Feb. 3-7.

Health region RPIWs work on shrinking wait times

One of the more important steps in alleviating patient wait times throughout the Five Hills Health Region (FHHR) is the conducting of Rapid Process Improvement Week (RPIW) sessions.

The three latest RPIWs of the 23 the health region has conducted since knowledge that a new hospital would be built in Moose Jaw were held Feb. 3-7. Two of them were held at the Moose Jaw Union Hospital, while the other was held at Providence Place.

RPIWs include a gathering of healthcare professionals and patients alike, looking to cut down on the amount of time patients wait for a variety of services.

One of the services that was analyzed and picked apart in one of the most recent RPIWs involved the physical therapy department.

A team of seven participated in what was known as RPIW 22. Their goal was to reduce the wait list for new outpatient referrals in the physical therapy department.

One of the group’s participants was Doreen Jerred, who previously spent time in physical therapy dealing with an injury. Her role was to provide a patient’s perspective on ways the department could work toward achieving its goal.

“They would ask me — being that I was there providing a patient’s perspective — what I saw and what I noticed,” Jerred told the Times-Herald. “I was more of a patient observer of the day-to-day functions that go on in the department.”

Physical therapists Arin McFadden and Alexis Kindrachuk also participated in RPIW 22.

As therapists, they knew heading into the RPIW that each of the physical therapists was responsible for the assessments of patients. This led to a variation in treatment plans administered to patients.

McFadden noted one of the ideas to shrink patient wait time in the physical therapy department was to utilize one therapist as an assessor. The other physical therapists would, therefore, follow the plan set out by that assessor.

“The patient would be immediately assessed by the physiotherapist and put into a category and their first appointment would be booked,” said McFadden.

She added part of the work the RPIW performed was to develop a 20-minute intake evaluation by a designated physical therapist to review a patient’s subjective concerns and make an appointment for the patient within a time frame that the assessor felt was appropriate.

In essence, this would keep a patient from being put on a waiting list.

“The idea would be that in a future state — after the current wait list is eliminated — this would be how everyone would enter into our practice setting,” said McFadden.

There were, however, other problems RPIW 22 worked on. The charting forms used by physical therapists were one of the problems identified.

Kindrachuk noted that physical therapists often rewrote the same things over and over again, many times each day. This, she said, leads to bad charting practices.

Thus, having more streamlined assessment plans for patients was something the RPIW looked at, which included check boxes for things that physical therapists assess on an everyday basis.

“It gave us the opportunity to give clearer goals on each assessment form,” Kindrachuk said of the new forms with check boxes.

“We also created some key phrases into the electronic system that we use for follow-up appointments.”

Instead of creating a table for every patient, Kindrachuk noted physical therapists like herself would only need to make a couple of clicks in the program and it would insert a template of what they were going to write out anyway.

“I think it is a good practice that they are doing,” Jerred said of the RPIW she was involved in.

“At the end of the week there were many efficiencies that were identified. There’s still a lot of work to be done in preparation for a new hospital, (but) it was definitely a lot leaner at the end than it was at the beginning.”

The RPIW conducted in the medicine ward also proved to be much leaner than at the end of it than at the start of it.

Dorinda Nordick, an environmental service worker, and Vanessa Entz, a licensed practical nurse, explained one of the techniques their group helped come up with to improve the communication between nursing and housekeeping.

It was as simple as a white board.

“It was suggested we have a tool on each end of the unit to assist with the communication issue,” said Nordick.

Thus, a communication board was established in each wing of the ward. Each board has all room numbers and indicates the status of each room, whether it is an isolated room, ready to be cleaned, ready to be set-up and more.

Entz and other members of the RPIW recognized there was no standard work for room set-up for both housekeeping and nursing.

“This was cause for being unprepared to efficiently receive and care for patients upon admission, or in case of emergency,” she said.

“We now have a standard work in place for both departments to ensure each room is prepared in a ready to receive state.”

Entz also said personal care times that patients and families commonly request, such as Kleenex and garment bags have been added to rooms before the arrival of a new patient.

Essentially, environmental service workers such as Nordick can now expect their days to be more prioritized.

The board RPIW 22 created is also an example of making the work of healthcare workers more visual, which is something the FHHR expects to be more the norm when the new hospital opens in 2015.

Nathan Liewicki can be reached at 306-691-1256 or follow him on Twitter @liewicks

Organizations: Moose Jaw Union Hospital, Times-Herald

Geographic location: Moose Jaw, Providence Place

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