Improving WeeFIM score completion rates: An interdisciplinary inpatient rehabilitation unit quality improvement project

Abstract

PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95%of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0%to 95%during the intervention period. On-time discharge completion rates increased from 0%to 89%during the intervention period. This change has been sustained over 2 years with on-time admission and discharge scores averaging 79.4%and 77.9%respectively, and 96.4%of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

“…Most included studies were conducted in the USA ( n = 47, 67%). 27-58,74,75,88,89,93,95-98,100-105 The only other countries represented by more than two manuscripts are the United Kingdom ( n = 10, 14%) 59-67,99 and Australia ( n = 4, 5.7%). 68-71…”

“…The acute care setting accounted for the largest number of included studies ( n = 41, 59%), 27,28,33,34,37,39-42,45,46,48,50,52,53,55,58,59,62,66,68,70-74,76-78,88,89,95-98,100-105 followed by the outpatient setting ( n = 19, 27%). 29-32,36,38,47,49,54,56,60,61,64,67,69,79,80,93,99 Other practice settings included inpatient rehabilitation ( n = 6, 8.6%), 36,43,57,65,75,76 home health ( n = 2, 2.9%), 44,63 other ( n = 2, 2.9%), 19,81 and academia ( n = 2, 2.9%). 35,51 The other category comprises a scoping review by Jesus et al 19 and a study by Steenbruggen et al 81 in which the practice setting was not made clear.…”

“…38,53,55,57,73,78,80,93 Other organization change models and data demonstration methods common to QI were rarely reported. Examples included process maps, 36,57,64,104 failure mode effect analyses, 38,42 fishbone diagrams, 53,58,67,73,78 and key driver diagramming. 38,45,57,64 Ethics Oversight…”

“…Of the 70 total included studies in this review, 18 (26%) 28,37,39,40,[43][44][45]48,52,60,68,70,73,74,77,79,96,102 were approved by local ethics boards, 19 (27%) [32][33][34]36,41,46,47,49,50,53,55,56,58,63,64,67,81,97,100 sought approval but were considered exempt, 15 (21%) 19,35,38,42,57,59,61,62,65,71,72,75,78,80,…”

“…49,60,63,66,68,69,81 Statistical process control charts were used as the lone analytic method in three studies (4.3%) 38,53,93 and were combined with descriptive statistics in five (7.1%) others. 42,48,57,73,78 Reporting Guidelines and Quality Assessment Only nine studies 19,38,42,50,52,56,62,77,96 referenced a reporting guideline, all mentioning the Standards for QI Reporting Excellence 2.0 (SQUIRE 2.0). 82 The median QI-MQCS score for the 66 nonreview studies was 12 (range 7-15).…”