The audit on the management of patients with stroke

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The audit on the management of patients with
stroke

• Charles Cheung
• Physiotherapy Department
• Tuen Mun Hospital

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Introduction

• 1700 patients with stroke adm. (98-99)
• Referral for rehab constituted 20 of total
  workload of inpatient rehab
• Physio manages patients according to the protocol
• A clinical audit was conducted to ensure the
  application of the protocol

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Objectives

• Audit the Physio care process
• Identify the key elements and content of
  Physiotherapy care process
• To see whether there will be improvement in the
  management for this group of patients

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Standards

• Internal standard

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Methodology

• Design
• Process audit
• Retrospective

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Methodology

• Identification of items
• Protocol was reviewed and crucial items on the
  standard assessment form were selected for audit
• Items included
• 1. Motor Assessment Scale
• 2. Problem identification
• 3. The care plan (goal specific)
• 4. The expected physical status of patients upon
  discharge

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Methodology

• Identification of items
• 5. Response time of therapist to referral
• 6. Whether therapist had made comment or
  recommendation on patients progress

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Methodology

• Subjects
• Patients admitted to MG wards with principal
  diagnoses of stroke
• Targeted no. of subjects 100

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Methodology

• Auditing
• A program worker retrospectively audited all
  patients records
• Physio sub-unit in-charge assisted in any
  uncertainty arose
• The compliance of completion of the foresaid
  items was audited
• LOS of patients

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Methodology

• Data analysis
• Descriptive statistics on compliance to items
• LOS was compared between patients in the study
  group and those admitted in year of 2000-2001
• LOS of subjects with physios and without
  physios comment was also compared

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Methodology

• Targeted compliance
• 100 for first 4 items
• Mean response time, not more than 2 days
• 50 for the last items

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Results

• From Feb 2002 June 2002
• 92 subjects were recruited
• Mean age 70.8 (42 to 96)
• 1 died during hospitalisation
• All others were discharged home or transferred to
  extended care for further rehab

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Results

• Compliance rate for first 4 items was 100 (Table
  1)
• Mean response time to referral was 1.0 day
  (SD0.5)
• Therapists had made comments on progress of rehab
  for 32 patients, i.e. 35

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Results

• LOS
• Mean LOS of subjects of the program was
  significant lower than those adm into TMH
  (plt0.05) (Table 3)
• No significant difference in mean LOS between
  subjects with and without comment (pgt0.312).
  However, it showed trend of lesser LOS for
  subjects being commented (1.2 days) (Table 4)

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Results

• Positive correlation of MAS scoring with the
  discharge destination (Table 5)

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Discussion

• Lesser LOS
• ? Prompt response
• ? Inclusion of treatment plan and goal as
  compulsory item ? MO better understanding of
  physical condition so as to make a prompt
  discharge planning of the patient ? discharged
  earlier
• ? Comments on patients rehab progress further
  enhance decision of rehab planning

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Discussion

• Correlation between MAS and D/C destinations
• Might provide an indicative information for
  therapist to make comment on the patients rehab
  progress

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Recommendations

• Include the documentation of the problem
  identification and goal-specific intervention as
  the compulsory items on the management of
  patients with stroke
• Therapists making comment on patients rehab
  progress in first few days after patients have
  been attended should be included as a compulsory
  item during the course of management of patients
  with stroke
• Adopt the MAS as a supplementary assessment of
  patients with stroke

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• Thank you

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