BC Hip Fracture

Redesign Project

CATCHING THE WAVE

Presentation to Collaborative Committee Showcase

February 24, 2016

OVERVIEW of Presentation

Background / Context

Goals & Objectives

Baseline Survey & Identification of Gaps

Priority Areas for Focus of Best Practices

Project Data Collection & Measurement

Improvements made

Legacy work

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Background / Context

Significant burden on health – high personal

and system costs

Priority population for government

Purposeful alignment with parallel initiatives

(e.g. ERAS, 48/6, Care Sensitive Adverse

Events, Safer Healthcare Now, Polypharmacy)

Consistent with BC Health System Strategic

Directions Document

National Best Practice Tool Kit defined

Canadian Standards

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Why focus on hip fracture care?

▪ Approx. 4,000 in BC have a hip fracture each year

▪ 22% will be back in hospital within 90 days

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Project Goals

Improve Patient Experience & Outcomes

Innovative, evidence-based clinical practices

Improved access to surgery

Lower mortality rates & complications

Improved patient flow

Reduced length of stay in acute care

Improved collaborative practice & transfer of care

Improved patient engagement in the care pathway

Data-driven change management 5

Hip Fracture Redesign Project

Funded by SSC

Phase 1: Pilot Project (8 sites)

Phase 2: SPREAD to additional 20 sites around BC

Add-on: Polypharmacy Risk Reduction Pilot in 3

surgical sites (Shared Care funding)

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Regional

level

Levels of support

Local site

Regional / HA

Provincial coordination

Local

site

Provincial level

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Approach

▪ Conduct baseline survey to review care & priorities for

improvement in 28 BC hospitals

▪ Engage surgeon, clinical and operations leads

▪ Map the patient journey

▪ Develop data collection tools and processes

▪ Implement standards of care and tools to support best

practices

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Mapping the Patient Journey

Prevention

Bone &

Falls

Hip

Fracture

~3900 / yr

(28 sites)

Transfer Admission Assessment

Procedure

POST-Op

Care

D/C

Planning

Home

New Facility

Same Facility TCU?

Bottlenecks

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Goals for Ideal Patient Journey

Prevent/minimize person-specific

complications thru proactive care

Maximize functional recovery

Maximize self–care management

Ensure appropriate follow up care

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Gaps in Care from

28 Hospital Survey

Project Response

Complications, morbidity,

LOS from delays to

surgery

Time to Surgery - within

48 hours of hospital admit

Surgery delayed due to

anticoagulation

Evidence-based Reversal

Guidelines

Pre-op & post-op best

practice gaps

Evidence based

provincial order sets with

supporting rationale

Timely, self-management

support for patients /

families

FRESH START Tool kit for

patients/families & care

givers 11

Gaps in Care from

28 Hospital Survey

Project Response

Staff, patient, & family

education & engagement

Project website, posters &

patient pathway

Lack of care coordination

Tools to facilitate

transitions/hand-offs in

care

No data on process &

outcome indicators to

support change

Minimum data set to track

key measures pre-post for

change analyses

Multiple meds leading to falls,

delirium, complications,

readmits

Polypharmacy Risk Reduction

(Partner with Shared Care) in 3

pilot sites

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▪ High functioning inter-disciplinary team of clinical leaders

from each health authority. Patient representatives

included

▪ Model of accountable care – focus on foreseeable risks

▪ Aligned with: ERAS, 48/6, Safer Health Care Now, Poly-

pharmacy Risk Reduction

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Best possible medication history & reviews upon hospital admission

Medication reviews / adjustments at touch points in collaboration with team/patient/family

Patient/Family medication management support

Clear discharge recommendations for patient, family, GP & pharmacy

Poly pharmacy Risk Reduction Interdisciplinary team uses QI

methods to determine how to do:

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Pre-printed Orders with

Rationale Document

▪ Template orders developed collaboratively with

health authority leads and surgeons

▪ Succinct rationale document with evidence to

support orders

▪ Site based stakeholder teams to customize, approve

and implement orders per HA processes

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Goals:

- Improve the patient experience & reduce readmissions

- Support patients /families to manage their care

Evidence based:

- Coleman’s model

- Safer Health Care Now

- Local research

In Punjabi & Chinese too

www.hiphealth.ca/research

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Dr. Maureen Ashe CIHR funded researcher. Formed

Initial Fresh Start team

Dr. Pierre Guy, Dolores Langford, Karen Tsui

Validated with 30 patients/families. 9/10 for usefulness.

Published: Patient Preference & Adherence. Sept 2015 Exploring older adults’ perceptions of a patient-centered

education manual for hip fracture recovery: “everything in one

place”

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Fresh Start Booklet

Prepares Patients/Families

▪ Understand their fracture, surgery & recovery

▪ Play an active role in preventing foreseeable risks e.g.

pneumonia, UTI, pain, falls etc.

▪ Know how/where to identify & communicate care needs

▪ Obtain equipment & support for home safety

▪ Recognize red flags & what to do

▪ Understand medication issues & safety requirements

▪ Arrange follow up appointments

▪ Undertake safe exercise

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Preventing foreseeable risk in hospital.

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Customize to patient Home Safety/Setup

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Staff/ patient collaboration to improve experience &

outcomes with a successful return home

22 http://www.hiphealth.ca/media/FReSH%20Start%20Manual_FINAL_Webready.pdf

Suggested standards for

Rehab Intensity

▪ Varies by discharge destination: home,

convalescent/ TCU, rehab, residential

▪ Formal and informal supports

▪ Assistive devices/equipment

▪ Early mobilization within 24 hrs post-op with

continuation of physical therapy @ 12 week,

6 months, and beyond for maintenance

▪ Self management skills & caregiver

education

▪ Use of 1:1 treatment and groups 23

Strategies for Improving

Access to Rehab ▪ Fresh Start booklet & SAIL program

▪ Phone follow up by a health care professional

▪ Utilization of home support & rehab assistants

▪ Knowledge of community resources - checklist

▪ Telehealth, video conferencing, phone coach

▪ Community-based group programs with

attention to transportation & access supports

Rehab Services

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Communication Checklists for

Care Transitions ▪ Key Transitions

▫ Admission through Emergency

▫ Discharge from acute care to home, convalescent

care, rehab, community or residential care

▫ Involvement of Family Physician / GP

▪ Inter-professional discharge checklists

▪ Patient/Family information

▪ Physician follow up

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