3la (501) Cardiac Rehabilitation Patient Survey 2011 Project team Name of project lead Other staff members involved Antoinette Brennan, Cardiac Rehabilitation Nurse Austin Lumley,Lynn Anderson, Clinical Audit & Effectiveness Administrator Wiqar Gondal, Clinical Audit & Effectiveness Facilitator Version: 1.0 Audit Date: November 2011 Report Date: 23 rd December 2011 Name of originator/author: Antoinette Brennan Date of multidisciplinary review of audit As below: results (where applicable): Name of responsible/approving committee: Date of committee meeting: 1
Contents Page Clinical audit report Project title 3 Division 3 Specialty 3 Disciplines involved 3 Project lead 3 Other staff members involved 3 Background 3 Aim 3 Objectives 3 Standards 3 Sample 4 Data source 4 Audit type 4 Methodology 4 Caveat 4 Results 5-11 Conclusions 12 Presentation/discussion 12 Recommendation 12 Audit learning points 12 References 12 Action plan 13 Appendix 1 Patient satisfaction survey 14-19 2
Clinical audit report Project title (501) Cardiac Rehabilitation Patient Survey 2011 Division Medicine Specialty Cardiology Patient Rehabilitation Disciplines involved Cardiac Rehabilitation Nurse Clinical Audit staff Project lead Antoinette Brennan, Cardiac Rehabilitation Nurse Other staff members involved Lynn Anderson, Clinical Audit Administrator Wiqar Gondal, Clinical Audit Facilitator Survey co-ordination and presenting of results Data entry Data analysis and report writing Background In January 2008 a patient survey was undertaken to determine what cardiac patients thought of the rehabilitation service offered at Hillingdon Hospital and how the service could be improved. As more than three years have passed since the previous survey it was decided to survey current patients going through rehabilitation. Aim The aim of this audit is to improve the rehabilitation programme so that it fully meets the needs and expectations of the patients. Objectives To identify what patients think of the programme and how it can be improved. Standards There are no standards for the rehabilitation programme but the results from the previous survey will be used as a comparison to indicate if patient satisfaction has improved. 3
Sample Surveys were handed out to patients between January 2011 and December 2011 until 100 completed surveys had been received, n=100. Data source Patient Satisfaction Survey Cardiac Rehabilitation August 2010 Audit type Patient survey. (Appendix 1) Methodology The method used was a patient survey, developed by the Cardiac Rehabilitation Nurse working with the Clinical Audit Facilitator, which was distributed to patients at the end of their rehabilitation programme. Completed surveys were returned to the Clinical Audit Team for analysis using Teleform and Microsoft Excel. Caveat Some patients did not answer all the questions on the questionnaire so the sample size is not the same for all the questions. Results are based on the responses given and the numbers of patients not responding to a question are stated in the results section of the report. The sample size for this year s survey was 100 patients but it is not possible to comment if they accurately reflected the demographics of the patients having rehabilitation with regard to gender and ethnicity.. 4
Results & Findings The following results give the responses to each question asked on the questionnaire. Q1: Were you offered cardiac rehabilitation when you were still in hospital? % of Patients 100 80 60 40 20 87 82 13 18 2008 2011 0 Yes No The percentage of patients offered cardiac rehabilitation has fallen slightly from 87% to 82%. This reduction is due to 25 more patients being from other hospitals in 2011 compared to 2008 Q2: Did the hospital staff explain the benefits of the cardiac rehabilitation programme to you? % of Patients 100 80 60 40 20 0 94 88 Yes 6 No 12 2008 2011 Most patients are still having the benefits explained to them although not as many from 2008. This reduction is due to 25 more patients being from other hospitals in 2011 compared to 2008 Q3: After you were discharged from hospital, how many weeks did you wait before joining a cardiac rehabilitation programme? Response 2008 2011 2-4 weeks 5 (16%) 40 (40%) 4-6 weeks 11 (35%) 38 (38%) More than 6 11 (35%) 16 (16%) weeks Can t remember 4 (13%) 5 (5%) Not answered - 1 Total 31 100 5
The percentage of patients on the programme within 6 weeks of discharge has jumped from 51% to 78%. The reasons given for over 6 weeks were; Although operation was done at Harefield it was only during a follow-up at Hillingdon that it was suggested. Not known Went into hospital for 3 days and so had to cancel first appointment It was my own fault, I delayed sending back joining form Changed health authority Consultant at Harefield said to wait 3 weeks after check up which was on the 3 rd of May I don t know why I wasn t well enough to take part in the classes I got another angioplasty after 3 month of heart attack I was previously attending community level 4 classes then had a severe head injury. I had a home physiotherapy assessment and home rehabilitation and then joined cardiac rehab level 3 to progress on to level 4. Waiting for right day of the week to start rehab programme Offered cardiac rehabilitation on follow up harefield hospital appointment I was waiting for a myoview scan, then it was postponed until a later date. I was also in pain for a quite a few weeks after I left Harefield Hospital. On holiday Q4: How would you rate the exercise component of the programme? 26 Excellent Good Fair Poor 74 6
Q5: How confident do you feel to continue to exercise on your own? No. of Patients 35 30 25 20 15 10 5 0 33 21 16 9 5 4 4 3 1 1 1 2 3 4 5 6 7 8 9 10 Not confident Confident If we took >5 as being more confident and <5 as less confident then 85% are confident to exercise on their own Three patients did not answer the question Q6: Are you going to continue to exercise? All patients said they were going to continue to exercise Q7: If yes, what exercise do you intend doing? Response No. of Patients Gymn 3 Other 6 Phase IV 2 Walking 38 Walking, Gymn 15 Walking, Gymn, Other 8 Walking, Other 21 Walking, Phase IV 2 Walking, Phase IV, Gymn 1 Walking, Phase IV, Gymn, Other 2 Walking, Phase IV, Other 1 Not answered 1 Total 100 7
Q8: Do you find health education talks useful? Response No. of Patients Yes 92 No 4 Not answered 4 Total 100 100 80 60 40 Yes No Not answered 20 0 8
Q9: Has it improved your knowledge that you can now make lifestyle changes? Response No. of Patients Yes 93 No 4 Not answered 3 Total 100 100 80 60 40 Yes No Not answered 20 0 The above graph shows we have empowered patients to make their own positive changes Q10: Are there any other topics you would have liked to have covered on the health education programme? The following responses were given; Exercise programmes for the enhancement of recovery/fitness during and after the rehabilitation More about food labelling, more different recipes of foods that are good for you and how to detect signs of heart trouble before they become a problem The dietician s programme could be more elaborate rather than superficial Detailed diet programme aimed at individual An in-depth chat from the cardiologist/surgeon who performs heart surgery. Sketch of the heart and explanation how different procedures are carried out on the heart. Not only talking. It should be practical training as well. Talking is time wasting. Some kind of support to people suffering from extreme stress Yes a sign language DVD to explain about heart, diabetes etc 9
A session on cardiac pain relief should have been presented regarding breathing etc Should of had a talk from cardiologist Q11: Has the cardiac rehabilitation programme also helped your family make positive lifestyle changes? Response No. of Patients Yes 74 No 18 Not answered 8 Total 100 The above table shows the impact the programme has on making positive changes not only to the patients themselves but also to their families. Q12: How much do you feel you have benefitted from the programme? 18 A lot Some Not much Not at all 82 Q13: Do you feel there could be any improvements to the programme? Response No. of Patients Yes 12 No 83 Not answered 5 Total 100 10
If yes, please indicate what might be improved? A home exercise regime plan should be created so that patients can continue exercising at home safely as some patients do not have access to a gymn. Have the programme running 3 times a week A bit larger room to do the exercise (room to move around) Practical training should be more than 6 weeks and should be 5 days a week and not 2 days The Rehab Centre in Hillingdon Hospital is too small to fit the real purpose. The staff are great, friendly and resourceful. The equipment are moderate, could be better. Investment is greatly appreciated. The six weeks is not long enough. A bit longer would give one more confidence when exercising alone. If possible, time and exercise in a swimming pool would be a beneficial session. Maybe more different sorts of exercise equipment too. A programme of home activities that could be communicated by handouts to enable exercise to be undertaken daily in a safe environment rather than 2 weeks at hospital: pedometer tasks, step ups/bends, non-equipment tasks Better gymn equipment, more varied equipment Bigger room, to be called back in 1 yr for exercise programme and to increase exercise classes from twice a week to three times a week. Length of course could be longer There are very different rehab requirements for each patient. Possibly having different streams based upon needs may help. More better and up to date equipment and machines. A better location within the hospital that is more up to date or the current facilities refurbished. Q14: How would you rate the cardiac rehabilitation programme overall? 20 Excellent Good Fair Poor 79 One patient did not answer the question. 11
Q15: Do you feel that your family benefitted from the rehabilitation programme or have found the programme useful? Response No. of Patients Yes 72 No 16 Not answered 12 Total 100 80 70 60 50 40 30 20 10 0 Yes No Not answered Q16: Has the programme improved your understanding of your condition? Response No. of Patients Yes 96 No 2 Not answered 2 Total 100 12
100 80 60 40 Yes No Not answered 20 0 Age Range of Patients No. of Patients 70 60 50 40 30 20 10 0 53 28 16 2 16-25 26-35 36-45 46-55 56-65 Over 65. One patient did not give their age Gender of Patients The respondents were 78 males and 21 females One patient did not give their gender Ethnicity of Patients No. of Patients 80 70 60 50 40 30 20 10 0 72 23 2 1 2 White Black Chinese Asian Other Not stated User Friendliness of Survey 13
All the respondents found the questionnaire easy to complete. Conclusions 82% of patients were offered cardiac rehabilitation whilst they were in hospital and 88% had the benefits of the rehabilitation programme explained to them All patients were satisfied with the exercise component of the programme rating it as either excellent or good All patients are going to carry on with exercise and have indicated that it will be predominantly by walking and using a gym Almost all patients now have enough knowledge to make lifestyle changes A small number of patients had suggestions for improving the programme and these included increasing the frequency of the classes and extending the duration of the programme. Several patients commented that better equipment was needed and that the current venue was too small. The overall satisfaction with the programme was very high with 79 patients rating it as excellent and 20 as good. Presentation/Discussion The audit results are to be presented and discussed at the Recommendations These will be agreed following the presentation of the results. Audit Learning Points Completing the patient questionnaire is optional and care may need to be taken to ensure that the respondents to the next survey reflect the patient groups (gender, ethnicity) taking part in rehabilitation. References Audit 199 - Cardiac Rehabilitation Audit of Patient Satisfaction (2008) 14
Project Number: 501 Clinical Audit Action Plan KEY (Change status) 1 Recommendation agreed but not yet actioned 2 Action in progress 3 Recommendation fully implemented 4 Recommendation never actioned (please state reasons) 5 Other (please provide supporting information) Project title Care of Patients with Learning Disabilities Staff Survey 2011 Action plan lead Name: Antoinette Brennan Title: Cardiac Rehabilitation Nurse Contact: Recommendation Actions required (specify None, if none required) Action by date Person responsible (Name and grade) Comments/action status Change stage 15
16
17
18
19
20
21