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Video transcript: Improving Together – Supporting Life After Stroke team

How the Middlemore stroke team used improvement methodology in their work. (English, 3 min 22 seconds)

Elizabeth, stroke patient with Amanda Shapleski, Occupational Therapist.

[Image of Elizabeth, stroke patient and footage of Elizabeth in her home, with Amanda Shapleski, Occupational Therapist.]

Elizabeth: Last year, November the 14th, that’s the day I was diagnosed with stroke and also diabetes.

Deirdre Gough, ESD Co-ordinator.

Deirdre Gough: So early supported discharge is a program in which patients receive intensive rehabilitation at home rather than in hospital, they are seen twice a day by allied health and once on a Saturday, in which they receive similar rehab to what they would get in hospital but at home.

[Image of the PDSA cycle diagram, and three questions]

Stephanie Easthope: The model for improvement has three questions. The first is what is it that we are trying to accomplish. So this is were the team really thinks about the aim of their project, and also defines the charter and the scope of their project before they start.

Deirdre Gough: What we were trying to achieve with the project, was to reduce the average length of stay for a patient who had, had a mild to moderate stroke by four days, and who lived in a small geographical location. We wanted to do this with comparable icons in the community, and we were also looking for a patient satisfaction rating of above 90 percent with the service.

Stephanie Easthope, Stroke Team Improvement Advisor

[Stephanie Easthope, Stroke Team Improvement Advisor, and image of the second question]

Stephanie Easthope: So the next question is how will we know that a change is an improvement?

So this is really about defining the measures that your going to use for the project, so that as the project goes along you can test out changes, and see if its having an impact on those measures.

So these are really the outcomes that your trying to achieve and any process changes that you want to make and identifying how you will measure those. The main measures that the team was interested in looking at, was the length of stay for patients in the rehabilitation ward in Middlemore hospital.

[Graph showing Outcomes: Reduced Length of Stay]

Stephanie Easthope: This would tell them whether or not having an early supported discharge service, which supported the patients out in the community instead of in the hospital, was having an impact on the length of stay, and hopefully reducing it.

Stephanie Easthope: The second measure was looking at the functional improvements that the patients were making. The third measure was around the patient satisfaction. So making sure the new environment and way of delivering the care, was satisfactory to paitients and also to their families.

The third question is what changes can we make that will result in improvement? So this is were the team takes their knowledge and understanding of the process or the system that their working in, any data that they’ve worked on, and start to develop change ideas and theories about what changes they could make, that will lead to the outcome they are looking for. And then they take those changes and start to test them out and see if that has an impact on their measures.

Deirdre Gough: Along with the strong research the early supported discharge, we felt that in order to bring the service to New Zealand we needed to test it, to know that it would work in our own environment. To ensure the safety of our patients, we started with one patient who was already ready to discharge, we then increased it to more patients and increased it to taking patients early.

[Footage of Elizabeth in her home.]

Elizabeth: The word home, it makes me really push myself and I just can’t wait to come home.

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