Process improvement:
Esthers scheduled for knee joint replacement or arthroplasty wanted to go home earlier and receive physiotherapy in the familiar home environment |
Esther coaches (physiotherapists), orthopaedic surgeons, nurses and finance personnel, worked out an enhanced recovery after surgery (ERAS) package that is financially viable and included two home visits by a physiotherapist or nurse |
Average length of hospital stay (LOS) after arthroplasty is 4 days Esthers felt they could sleep better and walk more if discharged from hospital earlier The ERAS programme was piloted to reduce the LOS and meet Esthers’ needs
|
ERAS was extended to about 1000 patients LOS improved from 4 days to 1 day Esthers’ functional abilities were not worse off and are being measured Programme has been scaled up; community partners are onboard to provide home care
|
Service innovation:
Esthers with Parkinson’s disease (PD) and experienced gait freezing wished to walk to the supermarket to do their own grocery shopping |
Esther coaches (community case managers and hospital physiotherapists) partnered with innovators from an institute of higher learning to produce a low-cost, portable laser light attached to a walking aid as a visual cue to reduce gait freezing |
Gait freezing is characterised by episodes of inability to produce effective forward stepping Visual cues like a laser beam are able to reduce gait freezing Products in market either have high cost, or are not designed for patients with walking aids
|
Esther tested the prototype and walked with minimal assistance for about 270 m Esther felt happy and rated her performance as 7/10; she planned to improve her endurance Esther gave feedback to improve the prototype, for example, to see the laser light better in sunlight This project is being scaled up to more patients with different types of walking aids
|
Improved clinical outcome:
Esthers wanted to increase their mobility and wean off urinary aids during their hospitalisation |
Esther coaches (physiotherapists and nurses) provided education to ward staff, patients and family members about the importance of walking; walking aids were placed conveniently at the bedside |
23 Esthers were recruited in one Internal Medicine Ward 100% of them were ambulant and 21% relied on urinary aids prior to hospitalisation During their hospital stay, although they were safe to walk, only 9% walked and 100% were put on urinary aids
|
Walking patients increased from 9% to 91% Daily walking increased from 1 to 3 times 97% of Esthers were weaned off urinary aids No complications were reported by Esthers Project has scaled up to 7 Internal Medicine wards
|
Increase in empowerment:
Esthers with frequent emergency medicine and hospital admissions preferred to live confidently at home |
Esther coaches (nurses and community partners) coproduced a care plan with Esthers that tailored to their recovery goals; home visits, telehealth services aimed to improve Esthers’ confidence in activities of daily living |
Mdm T had an average of 11 emergency medicine visits and eight hospitalisations in 5 months 63 Esthers with similar background and needs were enrolled Early collaboration among providers and patients helps patients meet their needs
|
Mdm T has had zero emergency or hospital admissions for 4 years after intervention In the sample of 63 patients, the median confidence score increased from 66 to 85 points after intervention The project has assimilated into a routine work process and is tracking hospital readmission rates
|
