Authors (including presenting author) :
Tam KL(1), Cheung TK(1), Wong HL(1), Chan HC(1), Tsang HC(1), To YL(1), Luk WY(2), Ng CK(2), Sun TF(3)
Affiliation :
(1)Physiotherapy department, North District Hospital, (2) Surgery department, North District Hospital, (3) HCE office, North District Hospital
Introduction :
Patients undergone open emergency abdominal surgery have higher risk of postoperative complications including pneumonia and venous thromboembolism, which delay recovery and lengthen hospitalization.
Since October, 2019, a new physiotherapy service model was implemented to identify high risk patients having received emergency abdominal surgery and provide early chest physiotherapy and mobilization to prevent complications.
Objectives :
To enhance the recovery of patients who have received emergency abdominal surgery through risk stratification, early postoperative intervention and enhanced holiday service.
Methodology :
Under the new service model, physiotherapists proactively screen patients who had emergency abdominal surgery through Operation Threatre Management System (OTMS) on weekdays. A list of criteria is used for risk stratification to identify patients with higher risk of complications. Early physiotherapy intervention is provided to high risk surgical patients. At post-operation day 0, immediate chest physiotherapy and anti-embolism stocking (TED) prescription are provided as indicated. At post-operation day 1 and 2, chest physiotherapy is provided twice daily with early out of bed mobilization as patient tolerated. From day 3 onwards, chest physiotherapy and mobilization with walking aids prescription service are provided to facilitate discharge of patients. Besides conventional holiday chest physiotherapy, additional out of bed mobilization service is provided as indicated.
Result & Outcome :
From October to November 2019, physiotherapy service was provided to 31 patients (Age: 29 - 89) with major or ultra-major emergency abdominal surgery done. 26 patients were screened and identified as high risk patient through OTMS on weekdays, other patients were referred physiotherapy service by Doctors. Among 31 patients, 6 patients received physiotherapy service at post-operation day 0. A total of 24 patients (77.4%) received at least one additional physiotherapy service twice daily in surgical wards and 22 patients (76.7%) were mobilized out of bed at post-operation day 1 or 2. No adverse events were reported.
The mean length of stay of patients received emergency abdominal surgery reduced from 18.6 days in October and November of 2018 to 15.9 days in October and November of 2019 (p< 0.05).
The new physiotherapy service model is safe and allows early identification of high risk patients received emergency abdominal surgery, for early postoperative intervention to facilitate patient’s recovery.
