Microsystem Improvement Assignment
A study by Vincent et al. (2012), discovered that BMI is directly related to length of stay, functional independence measure scores, and hospital discharge costs among those who underwent total hip arthroplasty (THA). In fact, patients who are severely obese have the worst inpatient rehabilitation outcome as compared to those with lower body mass index (BMI).If the patients’ obesity is not addressed after discharge, he could return in the hospital with other problems such as diabetes, hypertension, dyslipidemia, and/or metabolic syndrome (Nguyen et al. 2009). Fortunately, Rallidis et al. (2009) reported that though there is a greater risk for cardiovascular disease and diabetes with abdominal obesity, a Mediterranean-style diet can improve cardiovascularand insulin function in long run.
Purpose: To educate on proper nutrition similar to the Mediterranean-style diet in order to lose weight and improve cardiovascular function.
Patients: all inpatients in the orthopedic ward who underwent orthopedic surgery of any kind, especially those with BMI >25 kg/m2
Professionals: nurses, physical therapists, nutritionists/dietitians, physicians, surgeons, social workers, lab technicians.
Processes:
Common diagnosis: post-total hip and knee arthroplasty, post-open reduction internal fixation surgery, post-close reduction external fixation surgery
Treatment plans: (1) educating the patient and his family/caregiver on the risks of obesity, the components of proper nutrition similar to the Mediterranean style, computing for BMI; (2) asking nutritionists to prepare healthy meals in the duration of the patient’s confinement and to teach patients what meals they should eat and how to prepare them; (3) asking physical therapists to teach the patient exercises that not only help them return to optimal function after surgery but exercises to lose weight as well.
Follow-ups:(1) comparison of blood pressure, blood glucose, cholesterol and triglyceride levels before and after discharge; (2) encouraging patients to continue on a healthier lifestyle with proper diet and exercise.
Patterns:
Patient’s safety: Blood tests and exercise stress tests will be done before the program to ensure that patient has no other conditions that can be detrimental to the new lifestyle; results of the tests would also serve as a baseline to compare if the new diet and exercise program has any effect on the patient’s BMI and overall health. The goal is for the patient to have a normal BMI and lab tests.
Functional Status: Patient’s ability to prepare his own meals and to exercise alone or not. If patient cannot do these on his own, educating his family/caregiver is of paramount importance. Before discharged, patient and/or family should already know how to prepare the right meals and how to exercise to lose weight.
The physician should check patient’s compliance to the program during a follow-up check-up.
Theme:
Losing weight through proper nutrition and exercise.
Global Aim
We aim to teach inpatients with BMI >25 kg/m2 who had an orthopedic surgery on how to lose weight through proper diet and exercise. The process begins with educating patients with the help of nurses, nutritionists and/or dietitians, and physical therapists and ends with the patient having enough knowledge and ability to prepare their own meals and exercise. By working on this process, we expect these patients to lose weight and have a normal BMI and lab test results. It is important to work on this now because we want these patients to lead a healthy lifestyle as soon as possible.
Process Mapping reaction
Specific Aim
Obese patients will lower their BMI by 5 points while overweight patients will lower their BMI by 3 points after 5 months when they return for a follow-up check-up.
Cause & Effect: Fishbone Diagram
References
Godfrey, M. (2010). Microsystems at a glance.The Dartmouth Institute for Health Policy &
Clinical Practice. Retrieved from https://clinicalmicrosystem.org/getting-started-with-
microsystems/
Nguyen, Ninh et al. (2008). Association of hypertension, diabetes, dyslipidemia, and metabolic
syndrome with obesity: Findings from the National Health and Nutrition Examination
Survey, 1999 to 2004. Journal of American College and Surgeons. Retrieved from http://www.journalacs.org/article/S1072-7515(08)01322-7/fulltext
Rallidis, L. et al. (2009). Close adherence to a Mediterranean diet improves endothelial function
in subjects with abdominal obesity. American Society for Nutrition. Retrieved from
http://ajcn.nutrition.org/content/90/2/263.short
Vincent, H. et al. (2012). Effect of obesity on inpatient rehabilitation outcomes after total hip
arthroplasty.Obesity Society. Retrieved fromhttp://onlinelibrary.wiley.com/doi/10.1038/oby.2007.551/full
