ABSTRACT
Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS 1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient's homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients' homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention Results 91.5% total health outcomes improved or maintained by average: - FOF reduced by 22.5% - 180 degree turn improved by 43% - 60 sec Sit to Stand improved by 14.75% - Timed Up And Go improved by 15.5% - Confidence to cope at home improved by 15% - Pain / discomfort (self-reported) improved by 18.75% - Overall health (self-reported) improved by 8.5% Conclusion(s) Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients' connectivity to local voluntary and community sector services. Volunteers' mental health improves by engaging in meaningful service.
ABSTRACT
Background: Multidisciplinary clinics are the hallmark of cystic fibrosis (CF) care, but more experts often add time to the clinic visit. CF clinic appointment time at our institution extended to 170 minutes with approximately 6-8 disciplines per patent. To embed recent CF Foundation- supported scholars from Endocrinology (ENDO) and Gastroenterology (GI) into clinic, we sought to streamline visit time for patients and families without compromising multidisciplinary care. Objective: To maintain coordinated multidisciplinary clinic visit time at 120 minutes with the addition of ENDO and GI specialists after October 2019. Methods: A multidisciplinary quality improvement team including 2 parent partners met weekly to organize the initiative. We surveyed the CF clinic team to rank perceived barriers. We asked families perceived barriers to clinic through an added question on our clinic intake form and a survey to our Parent Advisory Council. Using pareto charts, we developed interventions to target most common barriers: 1) clinic road map to communicate across team which disciplines have priority patient assessments, 2) facilitator to decrease wait time between providers, 3) nurse-doctor (RN-MD) paired visits for shared communication and earlier RN sign-out of families. We tested interventions with plan-do-study-act (PDSA) cycles. We met hospital administrators monthly to accommodate PDSA cycles and adjust templates and rooms as needed. A subset of clinics were timed and displayed on a run chart monthly with interventions annotated. Visit time was compared before (5/2019-8/2019) and after (10/2019-3/2020) integration of ENDO and GI into clinic. Results: Survey of team members' perceived barriers to clinic had 24 responses. Most parent responses (14 of 19) reported concerns of wait time or visit length. PDSAs started in June 2019 before integration of ENDO and GI. Road map PDSAs adapted processes for improved use and integration of the tool. Clinic facilitator role was adopted with a medical assistant in the role. RN-MD pairs had positive feedback from both RNs and MDs. Prior to PDSAs, average clinic visit time was 127 minutes. Of 18 timed clinics, 7 had ENDO/GI provider present. Prior to ENDO and GI integration, clinic visit time was reduced to average clinic visit time of 121 minutes. Following integration, clinic visit time was maintained at 121 minutes. Proportion of clinic visit spent between waiting between team members was 26% (total time=31 minutes) which was also stable to slightly improved to 23% (28 minutes) after integration of ENDO and GI. Team members reported high satisfaction with all clinic visits finishing on time post-integration. Some families informally shared high satisfaction/noticeable change in duration of clinic visits. Conclusion: Interventions designed to address barriers in clinic flow demonstrated improvement in clinic visit time despite embedding 2 new subspecialists. COVID-19 limited further PDSAs for in-person clinic visits, however poises our team to address care coordination and communication for hybrid in-person and virtual models.