“Working as part of a supportive team during another challenging year; working with highly skilled, dedicated and compassionate clinicians who have gone above and beyond to continue to provide safe and effective care in a climate of significant change and unpredictability.”
– Rocco Mico, Respiratory Services Manager, NNSWLHD reflects on his highlights for 2021.
Rocco embarked on a journey during this challenging year with colleague, Tiphanie Lloyd, Exercise Physiologist, Lismore Pulmonary Rehabilitation (Pulmonary Rehab) by enrolling in the Clinical Redesign School. Their Clinical Redesign project was Lismore Pulmonary Rehab.
What is Clinical Redesign?
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- Redesign methodology provides clinicians and managers with a collection of tools and skills with the goal of improving service delivery in line with the quadruple aim.
- To facilitate this, the Centre for Healthcare Redesign (CHR) has been set up as part of the Agency for Clinical (ACI).
- Since 2007 the CHR have been offering training in redesign methodology.
- Redesign training includes Accelerating Implementation Methodology (AIM) and the CHR graduate certificate program.
Why Pulmonary Rehab?
[alert type=”danger”]Pulmonary Rehab improves quality of life and health related outcomes for people with an incurable progressive illness[/alert]Good for consumers
“Research shows that Pulmonary Rehabilitation (PR) is one of the best things you can do to improve your breathing and wellbeing. It also reduces the frequency of Chronic Obstructive Pulmonary Disease (COPD) exacerbations (flare-ups) and helps you stay well and out of hospital.” (1)
Good for Health systems
It is estimated that for every 4 people who complete PR, 1 hospital admission is avoided (2)
“ uptake of pulmonary rehabilitation is estimated to be only 5-10% of those people with moderate-to-severe COPD who could benefit related to lack of available programs, poor referral rates and poor patient uptake of existing programs.” (3)
Why Lismore?
- Lismore has the second highest admission rate for exacerbation COPD in our LHD.
- Lismore has the most exercise support resources out of any PR site in our LHD.
- Lismore was the only PR site that (at the time of project selection) had a dedicated clinician for exercise supp ort.
- A number of beneficial changes had occurred within the PR space due to COVID and needed to be captured, refined and further imbedded
- Previous experience working in the Lismore service.
Rocco has found the experience very rewarding.
“Working with the Lismore Pulmonary Rehabilitation team on a clinical redesign project has been an intense but amazing experience.”
Rocco and Tiphanie applied to enrol in the Clinical Redesign School in late 2020 and by February 2021 phase 1 began.
Phase 1 – Initiation (February-March 2021)
Phase 2 – Diagnostics (March-May 2021)
Phase 3 – Solution Design (May-July 2021)
Phase 4 – Implementation (July – December 2021)
Outcomes
The formal evaluation period for this project is January to December 2022.
What the patients think:
“Support, Well being, Specialist care, and Lung improvement – its a winner!”
“ It has helped me immensely, actually it has saved my life, I am a different person.”
“At the beginning of the program I was 30kg heavier and I had difficulties walking short distances on flat ground. My shortness of breath was debilitating and restricted the things I could do. Since starting the program I have slowly increased the length and intensity of my exercise and my fitness is now so much better than it was. The support I received helped me fulfil my goal of gaining fitness and losing weight. I am now much more confident and the exercise has really helped my lung function and mental health. The constant encouragement was the best part of the program. Regular contact by phone was very helpful with any problems I was experiencing and it also ensured I was accountable for staying on track.”
What the Clinicians Think:
“I am very pleased to hear that she has now stopped smoking as being connected with the pulmonary rehabilitation service. She is already feeling quite well, back on her feet and is now back at work.”
“(She) has been very well since last review. She is now down to 93kg with an aim of 89kg which is just fantastic (from 116kg). She has done the pulmonary rehabilitation class with Lyn and Tiffany, and did a six minute walk distance recently of 450m, this is excellent.”
“Thank you for revising the discharge summaries. I want you to know that I do read them. I find it very easy now to know exactly where a patient is up to and how much they are exercising.”
When asked about the biggest challenges in 2021, Rocco said “COVID-19 would have to be one of the most significant challenges. It has added a degree of complexity and consideration to almost all the work we do in health.”
Plans for 2022
Rocco is hopeful that 2022 will bring with it the opportunity to explore some of the many innovations that have been put on hold, “I look forward to working with our local teams and know we will find opportunity, regardless of what the year throws at us.”
1) Lung Foundation Australia website
2) Puhan et al. Pulmonary Rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 10
3) Alison, J.A et al. Australian and New Zealand Pulmonary Rehabilitation Clinical Practise Guidelines 2017