Utilizing Lean Methodology to Redesign Stroke Rehabilitation Team Rounds to improve Efficiencies. 

Background: The need for a highly-coordinated, specialized team, who meet regularly to discuss the rehabilitation goals and progress is a part of Stroke Best Practice Guidelines (Canadian Stroke Best Practices: delivery of inpatient stroke rehabilitation. 2016).  Quantitative measures such as Rehabilitation Intensity (RI), FIM efficiency and proportion of patients meeting the RPG length of stay provide quantitative measures of patient centered care. Staff and Patient satisfaction surveys are a method of measuring the qualitative improvements of our day to day work.  The rehabilitation unit at the Hamilton Health Sciences (HHS) did not have a consistent process for RPG (Rehabilitation Patient Groupings) availability and team rounds were lasting for over 2 hours which impacted direct patient care.

Methods:  The team participated in a process mapping exercise, which identified opportunities related to the rounding process. Staff satisfaction surveys and experience based patient questionnaires were conducted. Staff and Patient surveys demonstrated opportunities around pass processes and training. Three sub working groups were formed to address quality improvement opportunities: RPG Processes, Rounds Processes and Pass Processes. 

Results: Preliminary data shows a change in FIM efficiency from 0.96 to 0.98 as well as an increase in the RPG’s available to the team in rounds (54% in 2017/18 Q2 to 80% in 2017/18 Q3).  Further measurement to capture the length of time of rounds, RI improvements and the proportion of patients meeting their RPG targets are pending. 

Conclusion: Improving the efficiency of team rounds processes improves the quantitative and qualitative metrics in an inpatient rehabilitation program.