Abstract
Recovery in postoperative patients involves multiple domains including physical, physiological, psychological, social and economic aspects. Immediate postoperative physiotherapy (PT) is crucial for promoting early recovery and reducing hospital stay, particularly after common general surgeries like laparoscopic appendectomy, laparoscopic cholecystectomy and hernia repair. Despite its benefits, there is often a gap in the optimal delivery of PT services, as observed at Hazm Mebaireek General Hospital, where only 10.4% of postoperative patients were referred to PT. The project aimed to improve the Six-Minute Walk Test (6MWT) distance from 250 m to 350 m and the incentive spirometry inspiration volume (ISIV) from 927 mL/s to 1200 mL/s in acute care surgery (ACS) postoperative patients over a 12-week period. This was to be achieved by increasing the percentage of immediate postoperative PT referrals from 10% to 50% through multiple Plan-Do-Study-Act cycles. The project involved a multidisciplinary team of ACS surgeons, physiotherapists and inpatient nurses. The interventions included educational workshops, daily reminders and personalised reminders to on-call surgeons. Process, outcome and balancing measures were tracked to evaluate the effectiveness of the interventions. The percentage of immediate postoperative referrals to PT increased from 10% to 67.7%, surpassing the target. The average 6MWT distance improved from 247.17 m to 390.86 m, and the average ISIV increased from 927 mL/s to 1198 mL/s. There were no reported increases in fall incidents or pain following PT, indicating that the interventions improved care quality without compromising patient safety. The project successfully enhanced postoperative recovery through increased PT referrals, demonstrating the effectiveness of targeted educational interventions and systematic reminders. These findings suggest that simple, targeted interventions can significantly improve postoperative care. Future steps include institutionalising the successful strategies, expanding them to other departments and exploring broader applications to ensure sustainability and scalability.
Keywords: Postoperative Care, Quality improvement, Teamwork, Surgery, Patient-centred care
WHAT IS ALREADY KNOWN ON THIS TOPIC
Delayed mobilisation after abdominal surgery is associated with increased complications such as pulmonary issues, venous thromboembolism and prolonged hospital stays. Early postoperative physiotherapy and mobilisation have been shown to improve postoperative recovery; however, there is often a lack of standardised protocols in healthcare systems leading to underutilisation of these services.
WHAT THIS STUDY ADDS
This study demonstrated that a multidisciplinary quality improvement approach, including educational workshops and targeted reminders, can significantly increase postoperative physiotherapy referrals (from 10.4% to 67.7%). This improvement correlated with enhanced patient outcomes, including increased Six-Minute Walk Test distances and incentive spirometry inspiratory volumes.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
This project demonstrates the effects of integrating timely physiotherapy referrals into routine postoperative protocols. This approach not only improves recovery outcomes but also streamlines patient flow in surgical inpatient wards. Expanding similar strategies across other departments and advocating policy changes to include early physiotherapy as a standard quality metric could enhance care delivery and reduce healthcare costs.
Problem
Recovery is a return to pre-illness normalcy of multiple domains, namely physical, physiological, psychological, social and economic and is an active energy requiring process.1 Recovery of the physical and physiological domains of a postoperative patient is a multidepartment team effort involving physiotherapists, nurses and surgeons. Patients undergoing common general surgery procedures (elective and emergency) like laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), hernia repair (HR), and incision and drainage of abscesses in limbs risk developing cardiorespiratory complications, venous thromboembolism, sepsis, wound infections, postoperative ileus, etc.2 3 Physiotherapy helps in mitigating the risks of these potential postoperative complications and it does this by providing physical rehabilitation to assist a return of cardiorespiratory status and functional independence to premorbid levels.2 Immediate postoperative physiotherapy plays a critical role in promoting early recovery and reducing hospital stay after emergency general surgeries of the abdomen.4,6 However, despite the clear benefits of early mobilisation and physiotherapy in the postoperative period, there exists a notable gap in their optimal delivery across healthcare settings. Variability in clinical knowledge among healthcare professionals, coupled with a lack of standardised care protocols, often leads to an underutilisation of these essential services.7 This issue is compounded by a local culture that inadvertently promotes patient inactivity, leading to adverse outcomes such as pulmonary complications, thrombosis and increased mortality rates, thereby extending hospital stays and elevating healthcare costs.7
Addressing these challenges in implementing early mobilisation and physiotherapy protocols requires a concerted effort from all stakeholders involved in patient care. Hence, to identify the reasons for surgeons overlooking the immediate referral of postoperative patients to physiotherapists, we conducted an audit of patients undergoing emergency and elective general surgery procedures in the abdomen at Hazm Mebaireek General Hospital (HMGH), Qatar, between February and April 2023. This local audit revealed a concerning gap in this area, with only a small percentage of postoperative patients (10.4%) being referred to physiotherapy services promptly. This gap underscores the need for targeted educational and quality improvement initiatives to enhance the referral process, ensuring that patients receive the necessary rehabilitation services without undue delay. By fostering a multidisciplinary approach to postoperative recovery, healthcare providers can ensure that patients receive the comprehensive and holistic care they need for a successful return to their pre-illness state.
HMGH, under Hamad Medical Corporation network of hospitals in the State of Qatar, is a 118-bedded hospital which caters to adult male population of diverse ethnicity, belonging to low to middle socioeconomic background and residing in the Industrial Area of Qatar. The hospital has three inpatient wards with 102 inpatient beds split evenly- 34 beds each in the medical, surgical and joint Med-Surg wards along with 16 intensive care beds. The hospital also has six operating theatres with two rooms assigned to the acute care surgery (ACS) section. The physiotherapy section has five physiotherapists and the ACS section is staffed with five consultant surgeons and six specialists. The ACS section performs both emergency and elective procedures at HMGH with an average number of around 180 and 120, respectively, per month.
This quality improvement project (QIP) targeted postoperative ACS patients who underwent LA, LC or HR. The initial baseline audit also demonstrated that the average Six-Minute Walk Test (6MWT) was 250 m and average incentive spirometer inspiration volume (ISIV) was 927 mL/s in postoperative patients who were deemed dischargeable.
The general aim of the project was to improve the average 6MWT and ISIV values in ACS postoperative patients who underwent LA, LC and HR by increasing the percentage of immediate postoperative referrals to physiotherapy.
Background
Previous research studies have demonstrated that delay in mobilisation in the postoperative period predisposes to pulmonary complications and increased length of stay (LoS) after abdominal surgeries.6 The relationship between the degree of dependency and hospitalisation time is also established, indicating that patient dependency significantly and proportionally impacts post-surgery LoS.8
In a comparative study by Kabir et al, a combination of early mobilisation and respiratory physiotherapy techniques was more effective in improving the peripheral oxygen saturation level and functional independence rather than only chest physiotherapy after elective abdominal surgery.9 Similar positive physiological effects were demonstrated in a study by Svensson-Raskh et al in which postoperative mobilisation was done even as immediate as 2 hours after abdominal surgery.4 A more recent systematic review and meta-analysis found that early postoperative mobilisation appeared to accelerate clinical gastrointestinal recovery.10
In 2014, the analysis of data of 22 645 patients from 199 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program found that improving care efficiency and local postoperative recovery protocols could reduce excessive resource use through reduced LoS.7 The implementation of such mobilisation protocols has been shown to be effective in managing early mobilisation and improving patient care outcomes. This was well demonstrated in a study by Koyuncu and Iyigun in which patients who followed a structured mobilisation protocol and started mobilisation earlier and had better outcomes, including shorter LoS and higher satisfaction scores.11 A recently published QIP aimed to improve early postoperative mobilisation in patients undergoing abdominal surgery by implementing best practices. Their results showed significant improvements in compliance with best practice criteria, reduced length of hospital stay and increased postoperative physical activities. The study concluded that evidence-based practice effectively promotes early mobilisation and recovery in patients after abdominal surgery.12
Martinez et al demonstrated that individualised exercise programmes can effectively reverse the loss of activities of daily living that occurs during hospitalisation.13 Moreover, behaviour change interventions, particularly goal setting and feedback, result in increased physical activity in hospitalised patients.14 A technology-driven, goal-directed movement intervention using a movement sensor showed a significant increase in physical activity levels during hospitalisation, suggesting that such interventions could be beneficial in stimulating inpatient physical activity. These devices can provide real-time feedback to patients and healthcare providers, encouraging and increasing patient engagement in their recovery.15 16 These findings underscore the significance of adopting a patient-centred care approach through early and individualised mobilisation strategies in enhancing recovery and reducing complications after abdominal surgery.
Moreover, Svensson-Raskh et al explored the qualitative content analysis of interviews of patients who were mobilised immediately after elective abdominal cancer surgery, which revealed that patients viewed mobilisation as a critical component of their care, which positively affected their physical recovery as well as mental well-being, both immediately and over time. The major factors influencing their attitudes towards early mobilisation included their own motivation, experiences of themselves and others, preparation for the process and the competence of caregivers. The presence of competent caregivers and adequate preparation were crucial in making patients feel safe and confident during mobilisation. This research provides valuable insights for the development of early mobilisation protocols in hospital settings.17
However, there is very limited evidence and research that focus on the effectiveness of immediate postoperative physiotherapy in patients specifically undergoing emergency general surgeries of the abdomen.2 Additionally, during our literature review, the authors could not find any studies which provide values for 6MWT distance or ISIV prior to discharge, in a patient who underwent these surgeries.
Measurement
To identify the current state of postoperative physiotherapy (PT) interventions and their impact on patient recovery, we conducted a baseline audit for 6 weeks at HMGH inpatient surgical ward between February and April 2023. This audit included 162 patients who underwent emergency and elective general surgery procedures, specifically LA, LC and HR.
The audit revealed a significant gap in postoperative care: only 10.4% of postoperative patients were provided with PT services immediately after surgery. Visualisation of the causes with a Pareto chart and root cause analysis by 5 Whys and cause-and-effect diagram all revealed the main reason was that only 10.4% of patients were referred to the PT by the surgeon in the immediate postoperative period. This low referral rate indicated a lack of standardised protocols for PT referrals, which likely contributed to suboptimal patient recovery outcomes.
Two key metrics were used to assess the baseline functional status of patients before discharge: the 6MWT and the ISIV. The baseline average 6MWT distance was 250 m, and the average ISIV was 927 mL/s. Additionally, it was noted that patients who were not referred to physiotherapy demonstrated decreased cardiorespiratory status, mobility and functional independence. This likely affected their post-discharge recovery process and delayed their return to daily activities and work.
The baseline audit highlighted the urgent need for a targeted quality improvement initiative to increase immediate postoperative referrals to PT, aiming to improve patient outcomes and overall recovery times. The audit data served as a foundation for setting specific, measurable goals for the QIP, including increasing the percentage of immediate postoperative referrals to physiotherapy from 10% to 50% and improving the 6MWT distance and ISIV values over a 12-week period.
Design
Formation of the project team and initial assessments
The multidisciplinary project team comprised ACS surgeons, physiotherapists and inpatient nurses, who collaborated closely under the umbrella of ACS Quality & Patient Safety (QPS) Committee. The project team conducted comprehensive brainstorming sessions to perform root cause analysis, review available literature and identify gaps, barriers and facilitators to effective PT referrals. Using quality improvement tools such as strengths, weaknesses, opportunities and threats analysis and process mapping, we charted out the existing workflow and performed gap analysis to identify critical points where interventions could be applied. A Pareto chart was employed to visualise the primary causes of low PT referral rates, revealing that only 10.4% of postoperative patients were referred to PT services by surgeons in the immediate postoperative period.
Sponsor and stakeholder engagement and communication
Engagement of all relevant stakeholders was achieved through regular communication and dissemination of findings. We shared Pareto charts, root cause analysis and workflow gap analysis and demonstrated the necessity for improving the immediate postoperative PT referrals to key sponsors and stakeholders via corporate emails and by a project design presentation during QPS Committee monthly meetings. This communication strategy helped to secure buy-in from key sponsors and stakeholders, including ACS surgeons, PT staff, inpatient nurses and hospital administration. The ACS QPS Committee, after ensuring adequate patient-to-physiotherapist ratio to assess feasibility, approved the QIP design and data collection protocol.
Involvement of patients, carers or family members
From the outset, our project team prioritised the inclusion of patients, carers and family members to ensure the interventions were patient centred and responsive to real needs. We conducted initial focus groups with patients who had recently undergone surgery to gather insights into their postoperative experiences and recovery challenges. Family members and carers were also invited to share their observations and suggestions for improving postoperative care. This feedback directly shaped the educational materials and communication strategies employed in our Plan-Do-Study-Act (PDSA) cycles, ensuring that our interventions were well informed and adopted a patient-centred care approach.
QIP workflow
We analysed the electronic medical records of all patients admitted to the surgical ward under ACS who underwent LA, LC or HR for ‘Referral to PT’ order by the operating surgeon. Patients who were referred to PT had postoperative ambulation and incentive spirometer training provided by the PT team. Surgical ward nurses provided these services as per existing workflow to those patients who were not referred. The surgeons assessed all patients for discharge readiness during daily rounds starting from postoperative day 1, and when discharge criteria were met, we recorded the 6MWT and ISIV for every patient just before discharge. All the nurses in the inpatient ward were already trained in providing postoperative care protocols as part of their continuous training and education programme. After assessing the daily case mix of surgeries, the QIP team opted for a 4-day block for each data point. The PT team ensured completeness and accuracy of data entry by adopting a secured online data collection sheet on Microsoft Teams setup through the corporation’s secured workflow environment.
Reporting
Our QIP was conducted and reported in accordance with the Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines,18 which provide a structured framework for describing and evaluating interventions aimed at improving the quality, safety and value of healthcare. The use of SQUIRE ensured transparency and replicability in the design, implementation and analysis of our interventions
Strategy
Our SMART aim of the project was to improve the 6MWT from 250 m to 350 m and incentive spirometer value from 927 mL/s to close to 1200 mL/s in acute care surgery postoperative patients who underwent LA, LC or HR over a 12-week period by increasing the percentage of immediate postoperative referrals to physiotherapy from 10% to 50% through multiple PDSA cycles.
Since no specific values were found for 6MWT and ISIV in any international guidelines or publications in English language, during the design period of this study, we opted to set a target of 40% increase in 6MWT to 350 m and a 33.3% increase in ISIV values to 1200 mL/s.
Measurement framework
To evaluate the impact of the interventions, we established a robust measurement framework, incorporating process, outcome and balancing measures:
Process measure: percentage of postoperative patients referred to PT per block.
Outcome measures: average distance achieved in the 6MWT and average ISIV measured just before discharge.
Balancing measures: percentage of patients not referred to PT, number of fall incidents reported and number of patients reporting increased pain after PT sessions.
This comprehensive design ensured a systematic approach to improving postoperative care quality, leveraging iterative testing and stakeholder engagement to drive sustainable change.
PDSA cycles for iterative testing and refinement
The intervention strategy was implemented through a series of PDSA cycles, an iterative method used to test and refine changes in real time. Each PDSA cycle aimed to address specific barriers identified during the initial assessment phase and incorporated feedback from previous cycles to continuously improve the intervention.
In the first PDSA cycle, the focus was on building awareness and knowledge among ACS surgeons regarding the benefits of early PT intervention. We conducted a targeted educational workshop that highlighted the critical role of PT in postoperative recovery. During this session, we encouraged surgeons to routinely include ‘Referral to Physiotherapy’ in their immediate postoperative orders. We included patients who underwent LA in this PDSA cycle, and the effectiveness of this intervention was monitored by tracking the percentage of patients referred to PT immediately after surgery. This educational session slightly improved the referral percentage to 21.59%.
The second PDSA cycle aimed to reinforce the educational content and prompt timely referrals. This phase involved the implementation of daily reminders for the ACS surgeons’ group through the hospital’s internal communication system. These reminders served to reinforce the importance of early PT referrals. In this PDSA cycle, we broadened the patient cohort by adding those who underwent LC also. We continued to track the referral rate to evaluate the effectiveness of this intervention in enhancing compliance, which resulted in a significant increase in the referral rates to 59.75%.
In the third PDSA cycle, the focus was on ensuring accountability and establishing consistency of PT referral practices over time. We opted to send personalised daily reminders to on-call surgeons, specifically targeting those responsible for patient care on any given day. We continued to monitor the referral rates, adherence to the referral protocol and any fluctuations in referral patterns to measure the impact of this personalised approach. All patients who underwent LA, LC and HR were included in this cycle of PDSA and the referral rates remained consistently above the goal at 67.67%.
Results
By incorporating educational interventions and systematic reminders through three PDSA cycles, the project achieved the set goal of timely PT referrals. The percentage of immediate postoperative referrals to PT rose from 10% to 67.7%, exceeding the initial target of 50% (figure 1A). The average percentage of timely referrals steadily improved with each PDSA cycle (figure 1B). This increase in referrals was accompanied by notable improvements in patient recovery metrics and postoperative LoS.
Figure 1. Improvement in physiotherapy referral rates across baseline and PDSA cycles. The left chart (A) displays the percentage of postoperative physiotherapy referrals per block, showing a steady increase from the baseline phase (red line) through PDSA cycle 1 (yellow line), cycle 2 (blue line) and cycle 3 (green line). The dashed lines indicate target referral rates (green) and baseline rates (red). The right chart (B) shows the average referral percentages for the baseline and each PDSA cycle, demonstrating a significant improvement, with referral rates rising from 10.4% at baseline to 21.6% (PDSA 1), 59.8% (PDSA 2) and 67.7% (PDSA 3). Each block on the x-axis is a 4-day time block. B, intervention block; BL, baseline block; PDSA, Plan-Do-Study-Act.
The average 6MWT distance increased from 247.17 m to 390.86 m (figure 2A, B), and the average ISIV rose from 927 mL/s to 1198 mL/s (figure 3A, B). These outcomes indicate substantial gains in patients’ cardiorespiratory fitness and overall functional status before discharge. All patients enrolled in the study completed the PT sessions. Importantly, there were no reported increases in fall incidents or instances of increased pain following PT, affirming that the implemented changes improved care quality without compromising patient safety.
Figure 2. Improvements in 6MWT distances across baseline and PDSA cycles. The left chart (A) displays the average 6MWT distances (in metres) per block, showing gradual improvement from the baseline phase (red zone) through PDSA cycle 1 (yellow zone), cycle 2 (blue zone) and cycle 3 (green zone). The dashed lines indicate target distances (green) and baseline averages (red). The right chart (B) highlights the average 6MWT distances for the baseline and each PDSA cycle, showing steady progress from 247.2 m at baseline to 256.1 m (PDSA 1), 335 m (PDSA 2) and 390.9 m (PDSA 3). Each block on the x-axis is a 4-day time block. 6MWT, Six-Minute Walk Test; B, intervention block; BL, baseline block; PDSA, Plan-Do-Study-Act.
Figure 3. Improvements in ISIV across baseline and PDSA cycles. The left chart (A) shows the average ISIV (in millilitres) per block, highlighting consistent improvements from the baseline phase (red zone) through PDSA cycle 1 (yellow zone), cycle 2 (blue zone) and cycle 3 (green zone). The dashed lines represent the baseline average (red) and target volume (green). The right chart (B) illustrates the average ISIV values across the baseline and each PDSA cycle. ISIV improved from 927.3 mL at baseline to 1138.5 mL (PDSA 1), 1171.2 mL (PDSA 2) and 1198.1 mL (PDSA 3), nearing the target of 1200 mL. Each block on the x-axis is a 4-day time block. B, intervention block; BL, baseline block; ISIV, incentive spirometry inspiratory volume; PDSA, Plan-Do-Study-Act.
The project not only improved patient mobility and respiratory function but also contributed positively to reducing the average postoperative LoS of patients. Patients who received immediate PT referrals experienced fewer complications and a faster return to functional independence, which facilitated earlier discharge. Consequently, the hospital saw a decrease in the average LoS, highlighting the effectiveness of the project’s multifaceted strategy in improving both patient outcomes and hospital efficiency.
Discussion
This QIP underscores the potential of structured, low-resource, easy-to-implement interventions to substantially improve the quality of postoperative care in an emergency general surgery setting. The steep increase in PT referrals and corresponding gains in functional recovery metrics demonstrate the efficacy of a multifaceted approach that combined education, behavioural nudges and reinforcement, and targeted communication strategies.
The impact of these interventions extends beyond individual patient outcomes. Improved functional recovery facilitates timely discharge, optimises bed utilisation and reduces healthcare resource consumption. Importantly, the absence of adverse effects supports the safety of implementing PT early in the postoperative period when guided by trained professionals. Moreover, the positive reception by staff and patients indicates strong potential for sustainability.
Our findings align with existing literature that emphasises the benefits of early mobilisation and PT in reducing postoperative complications and accelerating recovery. However, this study uniquely contributes by offering a practical and replicable intervention model tailored for surgical patients undergoing common emergency abdominal procedures. By integrating PT referrals into the immediate postoperative workflow, we addressed a critical bottleneck in recovery optimisation—delayed mobilisation due to underutilisation of physiotherapy services.
This project adds a practical framework for translating that evidence into sustainable clinical practice, especially in resource-constrained settings. Notably, there is limited literature providing objective pre-discharge 6MWT and ISIV values in patients undergoing emergency general abdominal surgeries. This project contributes original baseline data and outcome trends that could serve as a reference for future quality initiatives.
Lessons
Several key insights emerged from this project. First, we learnt the importance of multidisciplinary collaboration. The engagement of surgeons, physiotherapists and nursing staff was crucial for the seamless implementation of the referral process. Robust collaboration across different disciplines by engaging all stakeholders in the design and implementation phases fosters a cohesive approach to improving patient care.
Second, continuous education and communication are vital. It is crucial to establish a routine communication system, such as regular educational sessions and reminders, to maintain high engagement, compliance and adherence to new protocols among surgical staff. Further sustainability strategies must include changes in existing protocols and guidelines.
Last, we recognised the value of patient and carer feedback in refining our interventions. This direct input helped us adjust our strategies with a patient-centred care approach that can significantly improve the effectiveness of care interventions, leading to better patient outcomes and satisfaction.
Limitations
This project was conducted in a single hospital that caters to only male patients, which may limit generalisability to mixed-gender populations. The focus on patients undergoing three specific types of surgeries (LA, LC and HR) further narrows applicability to other surgical disciplines or more complex procedures. The improvements observed could also have been partially influenced by the Hawthorne effect, wherein staff awareness of being observed may have temporarily improved performance. Last, the study lacked long-term (30 days) follow-up data post-discharge, which limits understanding of the sustained impact of early PT on full recovery, readmissions or long-term functional independence.
Future projects would benefit from multicentre implementation, inclusion of diverse patient populations and incorporation of longer-term outcome tracking to assess durability of benefits.
Conclusion
The project achieved and surpassed its aims, demonstrating the effectiveness of targeted educational interventions and regular reminders in improving referral rates and patient outcomes. The success of the project can be attributed to the engagement of surgical staff through education and reminders, along with the careful selection of interventions tailored to the hospital’s context.
The increase in immediate postoperative referrals to PT, a key process measure, directly correlated with improvements in the outcome measures of average 6MWT distances and ISIVs. This underscores the potential of simple, targeted interventions to significantly improve postoperative care.
Sustainability
To ensure the longevity of the improved postoperative PT referral process, we implemented several strategies. We institutionalised the referral protocols by integrating them into standard postoperative care to make PT referrals a routine for all ACS patients undergoing surgery. We introduced regularly conducted educational sessions and training for both new and existing staff to emphasise the importance of early PT referrals and maintain high awareness and adherence to these protocols. Additionally, we intend to establish an ongoing monitoring system into Electronic Medical Records programme to track referral rates, patient outcomes and balancing measures. This system will include a feedback loop for staff to report challenges and suggest improvements, fostering an environment of continuous improvement. We will also develop patient education materials that highlight the benefits of early physiotherapy, encouraging patients to actively participate in their recovery.
Scalability
The successful strategies from this project can be expanded to other surgical departments or procedures within the hospital, with necessary adaptations based on specific needs and workflows. Sharing the project’s outcomes and lessons learnt with other institutions through professional networks, conferences and publications can facilitate broader improvements and innovations. Benchmarking against other institutions will help set new targets for continuous improvement. Leveraging technology, such as electronic health records to automate referral processes and using mobile apps for patient education and outcome tracking, will further enhance scalability. Additionally, engaging with healthcare policy makers to advocate for early physiotherapy referrals as a quality metric and a reimbursable best practice can incentivise widespread adoption and support scalability efforts.
Acknowledgements
The authors gratefully acknowledge the invaluable cooperation of the inpatient nursing staff at Hazm Mebaireek General Hospital in supporting the successful execution of this Quality Improvement Project. The authors would also like to extend their appreciation to Ms. Safrina Latheef KP for her exceptional work in managing the project, designing the data visualisations used in this manuscript and the poster of the project, which was presented at the IHI International Forum in Hong Kong, August 2024.
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Patient consent for publication: Not applicable.
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient and public involvement: Opinion of patients, carers and family members were included to ensure the interventions were patient centred and responsive to real needs. During the baseline data collection, we conducted initial focus groups with patients who had recently undergone surgery to gather insights into their postoperative experiences and recovery challenges. Family members and carers were also invited to share their observations and suggestions for improving postoperative care. This feedback directly shaped the educational materials and communication strategies employed in our PDSA cycles, ensuring that our interventions were well-informed and adopted a patient-centred care approach.
Ethics approval: Ethics Committee or Institutional Board approval was not sought for this study. This was a Quality Improvement Project undertaken by a multidisciplinary team of Surgeons, Physiotherapists, and Nurses as part of the hospital’s continuous improvement strategy. All improvement interventions were designed with patient safety in mind, and the project did not involve any deviation from standard care protocols. The project proposal and interventions were assessed by the ACS QPS Committee for patient safety, confidentiality, and compliance with the Hamad Medical Corporation’s Vision, Mission & Goals. Protocol approval number—ACSQPS-2023-HMG-PHY-001.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data relevant to the study are included in the article or uploaded as supplementary information.