Implementing Prehabilitation in a Tertiary Vascular Centre A Quality Improvement Journey

Purpose

Prehabilitation is enhancing a patient's functional capacity before surgery, with the aim of improving postoperative outcomes, and should include medical optimization, physical exercise, nutritional and psychological support. Prehabilitation prior to vascular surgery has been recognised in the more recent GIRFT report [2018] .We developed a prehabilitation programme for patients awaiting AAA repair at a tertiary referral vascular centre with a high number of patients undergoing aortic aneurysm surgery

87% of patients
felt it was important to get fit prior to major surgery
50%
were happy to commit to an exercise regimen

Approach

The programme included a single on-site workshop, as well as a home-based instructional pack, including exercise suggestions, nutritional advice and smoking cessation guidance.

PDSA Cycle 1: The planning phase Ad hoc basis for patients following their clinic appointment, jointly delivered by physiotherapist and anaesthetist. Questionnaires were issued to help us understand the concerns of our patient population and generate an idea of interest in the programme.

PDSA Cycle 2: Introduction of the R2R Workshop The Road to Recovery (R2R) Workshop was established and staffed via business plan. Scheduled on a fortnightly basis. Patients were identified by the vascular CNS and invited to attend either by letter or a phone call and an exercise programme added.

Cycle 3: Modifying the R2R Workshop Efforts to make the programme more sustainable were made including business cases for staff and job planning for aneasthetists.

Cycle 4: Establishing Sustainability Established job planning and successful buisiness cases for staff, further engagement with surgical colleagues and changes to IT infrastructure meant an increase in up take of R2R.

Cycle 5: Continuing Improvement Data collection continues with regular audit

Outcomes

Cycle 1. Responses from 31 patients demonstrated the following: 87% felt it was important to get fit prior to major surgery, 50% of respondents were happy to commit to an exercise regimen, while the remaining 50% were unsure, but none were against taking part in a preoperative exercise programme. Patients described the session as “confidence building and informative”.

Cycle 2: Over three months, 22 patients attended a total of 7 R2R workshops, feedback was incorperated so that the workshop became more physically active and to include more specific guidance on nutrition and smoking cessation. The items given to patients to take home now also included a diary card of their activities and patients were asked to bring this back with them when they returned for surgery.

Cycle 3: Over the next 3-month period, a total of 12 patients attended 4 R2R workshops. Patient feedback remained excellent.

Cycle 4: 27 patients atended over 3 month period. Issues of anxiety and rupture from patients were addressed and a prehab pack developed

Cycle 5: Competitive grant money obtained for formal pilot study. Feedback from patients and staff members were unanimously positive. Workshops are now established within the AAA pathway.  

Setting up and running prehabilitation is difficult and relies on goodwill in the first instance as financial benefits are hard to derive. Establishing patient input is key and involving all members of the MDT - including admistration satff is essential.

Implications

Setting up and running prehabilitation is possible and acceptable to patients in this group.

Fund acknowledgements

none

Additional notes

This work was presented at Physiotherapy UK 2019