PDSA analysis of four salient components of the programme during Cycle-2
| Plan | Deliver the first three patient education classes and roll-out all aspects of the programme as a pilot, before full roll-out of the programme with all eligible patients. |
| Do | The first ER class was on the 6/10/2017. Recruitment monitored until 6/12/2017. |
| Study | Class attendance, drop-out rate and short-term outcomes were primary quantitative measures. Twenty-two patients were recruited and attended ER classes. Of these, 6 patients developed problems that precluded surgery, leaving 16 who proceeded to surgery. Two patients failed to attend the class, but were subject to all other aspects of the programme. Average LOS was 1.75 days. Average 3-month postoperative OSS and CS were 35.1 and 52.9, respectively, suggesting no early adverse effects of the programme on functional outcomes. One complication was observed in this 3-month period, a haematoma. Regular updates between the project lead (arthroplasty practitioner) and MDT identified problems which could be shared for potential solutions. Informal feedback was gained from the early class attendees and comments invited. In response areas for improvements in terms of the class set-up and ‘meet and greet’ for patients were identified. |
| Act | Application made to appoint a volunteer to assist in class set-up, and provide a ‘meet and greet’ service for patients. Fine-tuning of class content between professionals also undertaken. No adverse responses to any aspect of the programme were noted. Progression to full roll-out of the service to all patients with TSA therefore agreed, with further monitoring. |
CS, Constant Score; ER, enhanced recovery; LOS, length of stay; MDT, multidisciplinary team; OSS, Oxford Shoulder Score; PDSA, plan–do–study–act; TSA, total shoulder arthroplasty.