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Raising the Bar in Rehab

Difficult Execution

Published May 27, 2010 10:28 AM by

It wasn't often in school when we were given group projects, maybe two to three times per semester total. We all had different parts of the project we were responsible for. Considering our educations were so similar, our similar knowledge bases and same school schedule - it's likely that any one of us could have completed the parts assigned to our classmates. We went through the motions of these projects and in the end felt like working together was fine, but not much different from working on a project alone. Teamwork to us meant more hassle than collaboration; more competition for grades than effective solutions.

Enter into the real world. I have been working with a few staff to develop some mobility tips to improve and increase the activity of our patients during their hospital stay. I won't call it a "protocol," but I'm not sure how to describe it other than that. Having read a few different articles regarding mobility in the ICUs and long-term improvements, we wanted to incorporate those ideas into our daily routine of care.

I can't believe how different this project is compared to what was habit during school. First off, I have little to no free time during the day. My scheduled patient therapy sessions are time-consuming, and with documentation I have very little extra time for research or additional projects. Furthermore, my project teammates and I work very few days simultaneously, so our communication must be direct. We took our long-term goal and broke it down into smaller pieces, trying to complete as many of those pieces as we could at a time.

There were a lot of smaller, unanticipated barriers we found along the way. Hospital policies and opinions from other health care providers were the most prevalent - but most of these arose out of concern for the patient and safety for caregivers. Secondly, our work schedules didn't align often, so we learned how we needed to capitalize on our precious time to maximize outcomes for the project. We learned how to be more direct in our conversation and upcoming, self-imposed deadlines in order to be more efficient.

I remember hearing a quote once, "In order to do something good, you actually have to do something." I want my patients to get the best care possible. I want to be an active participant in researching outcomes and educating my coworkers about the things I learn. I'm hoping this is just one of many opportunities I will have to collaborate with other disciplines to improve our patient care.

What about you? Have you ever tried to implement changes in your practice setting? Were you surprised by the complications?


Hey Lisa, Great to see you striving to improving your patients experience and outcomes from your interventions. I've recently inherited a falls unit here in the UK. It needed work from a rehab point of view. Here's how I approached it.

First, I gained the trust of the other stakeholders (nurses) by listening carefully and always showing respect for their input.

Second, I learned as much about the system as I could. The NHS has very specific guidelines about acceptable evidence based practice

Third, I did a literature review about what studies had been done to support what I wanted to accomplish and where there were gaps in evidence. Lots of studies exist on falls whilst in a facility but almost none on community dwellers

Fourth, I devised a multidisciplinary approach to the problem which empowered therapists, nurses, and the patients to all be active players in the recovery process.

Currently, I've won the support of all the stakeholders and have implemented the plan. I've contacted the clinical audit team and plan to do a study about the outcomes with publication a real possibility.

This has not been an easy task for someone only in the country for 6 months but I believe will prove of significant value to the patients and the system on the whole. Good luck on your project!

Cheers, Dean Metz

Dean Metz May 27, 2010 4:15 PM

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