Category: Stroke; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective :
The change in FIM score from admission to discharge is an important metric tracked in inpatient rehabilitation. It indicates improvement made throughout the admission and this is utilized to rank rehabilitation hospitals. The objective was to improve these scores for the stroke-specific population by focusing on improving staff engagement and attention to this metric.
Design : Quality improvement project
Setting : Large urban inpatient rehabilitation project
Participants (or Animals, Specimens, Cadavers) : Therapists comprising the "stroke team
Interventions :
Quality improvement ideas were implemented focusing on improving staff education and engagement regarding this measure to improve low FIM scores despite overall extraordinary care. Targeted staff initially participated in discipline-specific re-education on accurate FIM score scoring techniques. Simultaneously, documentation methods were assessed to ensure that information documented was flowing accurately to the IRF-PAI. Next, focus was placed on increasing the staff attention to this metric by maximizing discussion of this outcome measure: FIM tracking techniques were implemented for real-time and retrospective analysis of FIM change in each of the areas and constant conversation about these scores was encouraged at the staff level using various communication methods.
Main Outcome Measure(s) : FIM change for patients with a primary diagnosis of stroke
Results : Prior to project (fourth quarter 2017): Average FIM change 23.02 with percentile rank of 35%. Data was tracked through the third quarter of 2018: September 2018 data showed FIM change of 32.92 and percentile rank of 93.42%.
Conclusions : Focusing on staff education and engagement without change in patient treatment led to significant gains in the metric of concern. Techniques presented can be utilized in a variety of settings to improve site-specific metrics.
Jaime Gillespie
– Physical Therapist, Baylor Scott & White Institute for Rehabilitation, Dallas, Texas