Catching the Waves: Best Practices, BC Hip Fracture Redesign
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Transcript of Catching the Waves: Best Practices, BC Hip Fracture Redesign
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BC Hip Fracture
Redesign Project
CATCHING THE WAVE
Presentation to Collaborative Committee Showcase
February 24, 2016
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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
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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
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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
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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
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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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