ABSTRACT
Objective: To improve compliance of post-stroke patients attending outpatient rehabilitation from 65% to 80% after discharged from an acute inpatient rehabilitation unit within a 1-year period. Design(s): Quality improvement project Setting: Acute inpatient rehabilitation unit Participants: Rehabilitation team members and poststroke patients Interventions: Root causes were identified by fish bone analysis. The most important root causes were subsequently determined by Pareto vote. Using a tree diagram and prioritization matrix, 2 specific interventions were developed. Firstly, on a specific day of the week, assigned rehabilitation nurses would check if outpatient referral to local rehabilitation center was completed and submitted by the team. This intervention was presented at the department meeting to promote awareness among staff about the importance of timely referral. Secondly, when a patient with stroke was identified to be suitable for outpatient rehabilitation, he/she would be briefed by the team about the importance for outpatient rehabilitation and given an education pamphlet. Main Outcome Measure(s): Compliance, measured by percentage of patients with an arranged appointment for outpatient rehabilitation services within a week of discharge Time, measured as time taken for outpatient referral creation to submission of referral. Result(s): Compliance improved from 65% at baseline to 75%. Time taken for creation of referral to submission was reduced from 7.8 days to 1.4 days. Conclusion(s): We did not achieve our goal of 80% compliance rate likely due to small sample size and COVID-19 pandemic with concerns of safety for elderly to attend outpatient rehabilitation. The improvement was 10% which could have been partially accounted by the suspension of outpatient rehabilitation services during the circuit breaker period which was a nationwide partial lockdown, instituted by the government, to contain the spread of COVID-19 in Singapore. Nonetheless, the improvement is still of significance, as studies had showed functional improvements gained while in inpatient rehabilitation were reinforced and maintained in outpatient rehabilitation.