Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Chan KW
Leung SM
Kam SW
Lee S
Affiliation :
Physiotherapy Department, Prince of Wales Hospital
Introduction :
Patients with history of habitual inactivity and diagnosed or undiagnosed cardiovascular disease, face an elevated and temporary risk when undergoing physiotherapy interventions involving aerobic exercise. The purpose of exercise risk stratification is to mitigate the likelihood of sudden cardiovascular events during exercise. The risk stratification protocol in department adheres to the American College of Sports Medicine (ACSM) for Exercise Testing and Prescription. To prevent sudden adverse cardiovascular event, follow-up actions according to the stratified results should be taken cautiously. However, in busy treatment area, not all co-workers could clearly identify at-risk patients and take appropriate actions accordingly.
Objectives :
1.To update and equip all staff working in the outpatient department (OPD) with the knowledge required to stratify patients into different risk stratification groups for exercise and the appropriate corresponding follow-up actions.
2.To translate theory into practice by labeling at-risk patients with different color-bracelets based on their risk stratification results, so staff in the treatment area could easily identify patients at-risks and take appropriate follow-up action to prevent cardiovascular event.
3.To audit the compliance on risk stratification and the occurrence of cardiovascular incidents associated with aerobic exercise.
Methodology :
1.In-service trainings were conducted for all OPD staff, focusing on the updated risk stratification method and the corresponding follow-up action. Therapists were encouraged to assign color-bracelets to patients based on their risk stratification. Different color-bracelets represent different follow-up actions.
Green: Close monitoring during aerobic exercise
Red: Contraindication to aerobic exercise
Purple: Precautions related to fall risk or fragility
Gradual and incremental progression of exercise intensity were emphasized to mitigate the occurrence of sudden adverse cardiovascular events. Staff in the treatment area should pay attention to patients with color-bracelets and take appropriate follow up action accordingly.
2.Audit for Risk Stratification Compliance:
5% of the total new cases in OPD for individual treatment from 27/11/2023 to 1/12/2023 were selected for audit of compliance of risk stratification and respective follow-up actions needed.
Result & Outcome :
The Compliance of Risk Stratification and corresponding follow-up Actions were 95.8% and 91.7% respectively. The overall combined compliance rate was 93.8%. Over the past year, there have been no reported cardiovascular incidents associated with engaging in aerobic exercise.
Implementation of risk stratification and utilization of color-bracelets had been established as standardized procedures. Close monitoring during aerobic exercise and special attention to fragility or fall risk patients can be carried out more effectively and efficiently through easy identification of color-bracelet.
