Amputee patients were staying in the hospital for extended periods of time due to poor healing and outcomes. The physio department used a machine traditionally used to treat back and joint pain, to increase wound healing time. The machine decreased the patients' length of stay by 20% and reduced edema. This decrease in edema assisted in less need for the shaping of the stump.
Innovation Summary
Innovation Overview
In September 2014, the Clairwood Hospital Physiotherapists started a project as a way for reducing the length of hospital stay for amputee patients and improving their outcomes. Patients were staying in the hospital for up to 9 months and once they received their prostheses, some were not using them effectively. The main goal of the project was to reduce the healing times of amputee patients by 25% and reduce swelling in the residual limb. This would help to decrease the time taken for the shaping of the residual limb. The patients were put onto a program of using a shortwave therapy machine.
Pulsed shortwave therapy (PSWT) had recently been shown to halve healing times of wound in patients. This machine was applied to patients 3 times per week for 15 minutes per day. The patients were monitored through weekly photographs of their wounds and patients length of stay was analyzed for a year prior to and post implementing the application of PSWT.
Implementation:
The physiotherapist in charge of the female amputee patients’ ward initiated the project using the recommendations stipulated by the research. The machine was initially housed in the physiotherapy gym but as the treatment length was 15 minutes, only 4 patients were able to be seen during their hour-long exercise class. We, therefore, moved the machine to the ward to ensure all patients who required it could easily access it during the day. The patients were seated on a wooden chair after walking there or using a wheelchair as necessary. They would put their residual limb on a wooden bench placed between the electrode plates. The machine was set using the specified parameters, this was that it must be pulsed with the longest rest interval possible for the machine and the amplitude should be less than 50%.
The reason for this is that the results obtained needed to occur without any heating of the tissues. Circulation would be improved with increased uptake of inflammation products and increased delivery of healing products. As dressings were changed every Friday and Monday, Friday was selected for the weekly wound photograph to be taken, they were stored on the computer under the patients’ initials and a comparison was done visually.
Impact:
The visual assessment of the patients’ wounds clearly showed improvement in the healing week on week, some patients’ wounds were completely healed in just 4 weeks. It was also noted that the patient’s’ edema was reduced post healing thereby ensuring that shaping of the residual limb was easier and took less time. The average length of stay (using monthly statistical records) of female amputee patients’ was calculated from 01 October 2013 – 31 August 2014 (pre-intervention) and compared it to the average length of stay from 01 September 2014 – 31 July 2015 (post-intervention). The average length of stay pre-intervention was 157, compared to 111 days post-intervention. The results showed a marked decrease in hospital length of stay of 46 days. This was a decrease of 29.2% in length of stay of female amputee patients’ post-PSTWT intervention.
As the edema was reduced post PSWT, there was less of a need for the use of bandages for the shaping of the limbs. This reduced the need for consumables and the patients’ were able to attend the Amputee prosthetic clinic in less time. Sustainability: This project is easily sustainable as the machines are currently in place is each surgical ward; we were able to obtain an extra machine from another hospital that had no need of theirs. We now have one in both the male and female surgical wards. The physiotherapists and physiotherapy technician were all trained on how to utilize the machine correctly. The new staff is trained as their rotation takes them through the wards with amputee patients’. The procedure is clearly explained and the nurses and patients are fully aware of the service and because they are able to clearly see the results, they are motivated for the project to continue.
Innovation Description
What Makes Your Project Innovative?
This modality is usually used for treating muscular pain and has only recently been shown to improve wound healing and reduce swelling. There were only a few research articles showing the benefits at the time so the results were closely monitored in the first year to ensure that clear benefits were seen through the wound photographs from week to week.
What is the current status of your innovation?
The SWT machines needed to be housed in the wards instead of the physiotherapy gym or ease of patient access. There were difficulties with the nurses and cleaners on the wards initially as the machine would be constantly moved but once the project was clearly explained to and the results noted by them, a designated space was agreed upon and the machines remain in their given spaces to this day. The patients’ propel or ambulate to the machine themselves to await therapy.
A contraindication to using this machine is pregnancy and as some of the physiotherapy team members have been pregnant over the course of this project, the physiotherapy technician was trained to ensure the continuation of patient care without placing the physiotherapist at risk. The PSWT machine is only able to improve blood flow where it is functional therefore the patient needs to be counselled extensively with regards to dietary and other lifestyle changes (e.g. smoking cessation). Outcomes and results are more clearly and easily seen when the machine is utilized in patients’ who have a comply with these changes.
Innovation Development
Collaborations & Partnerships
The nurses in the hospital assisted in examining wounds when therapists were unable to do so. The dieticians were asked to assist with any vitamins that would encourage wound healing. The occupational therapists were involved in making splints for below-knee amputees to limit contractures.
Users, Stakeholders & Beneficiaries
The patients were involved by positioning themselves by the machine and consenting to photographs of their wounds as required.
Innovation Reflections
Results, Outcomes & Impacts
The visual assessment of the patients’ wounds clearly showed improvement in the healing week on week, some patients’ wounds were completely healed in just 4 weeks. It was also noted that the patient’s’ edema was reduced post healing thereby ensuring that shaping of the residual limb was easier and took less time. The average length of stay (using monthly statistical records) of female amputee patients’ was calculated from 01 October 2013 – 31 August 2014 (pre-intervention) and compared it to the average length of stay from 01 September 2014 – 31 July 2015 (post-intervention).
The average length of stay pre-intervention was 157, compared to 111 days of post intervention. The results showed a marked decrease in hospital length of stay of 46 days. This was a decrease of 29.2% in length of stay of female amputee patients’ post-PSTWT intervention. As the edema was reduced post PSWT, there was less of a need for the use of bandages for the shaping of the limbs. This reduced the need for consumables and the patients’ were able to attend the Amputee prosthetic clinic in less time.
Challenges and Failures
The SWT machines needed to be housed in the wards instead of the physiotherapy gym for ease of patient access. There were difficulties with the nurses and cleaners on the wards initially as the machine would be constantly moved but once the project was clearly explained to and the results noted by them, a designated space was agreed upon and the machines remain in their given spaces to this day.
The patients’ propel or ambulate to the machine themselves to await therapy. A contraindication to using this machine is pregnancy and as some of the physiotherapy team members have been pregnant over the course of this project, the physiotherapy technician was trained to ensure the continuation of patient care without placing the physiotherapist at risk.
Conditions for Success
The physiotherapy staff to operate the machine and the shortwave machine is necessary for the project to be a success.
Replication
Many of the hospitals in EThekwini were given Shortwave Therapy machines as part of the MERP project a few years ago. This is a project where machines are given out to hospitals on a needs basis. Our hospital was given one but others were given 5 or more. Physiotherapists are trained in using this machine at the undergraduate level so it would not be difficult to explain the procedure and settings. The physiotherapists at Clairwood were able to hand over to each other without incident and this program has been running for 3 years.
Lessons Learned
Staff training each other on the use of the machine and the physiotherapy technician worked well as there was never a lapse in service. Explanation to the patients and eventually word of mouth between patients ensures that the patient is always available for treatment and actually queue for therapy. Having the machine in the gym was not user-friendly so two machines were placed inwards.
Status:
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
Innovation provided by:
Date Published:
29 May 2017