Fragility Fracture And The Hip: What Are The Key Elements Of Streamlined, Efficient And Cost...
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Transcript of Fragility Fracture And The Hip: What Are The Key Elements Of Streamlined, Efficient And Cost...
Streamlined, efficient and
cost effective care of the hip
fracture patient
Debra Long
Princess Alexandra Hospital
• PA Hospital founding member of Health Round Table
• Role of Health Round Table:
– Benchmarking
– Collect, analyse and publish information to improve operational practices
– Promote collaboration and networking
Catalyst for NOF initiative was due to poor performance on HRT in 2006
Areas of concern
• Length of stay in ED
• Time to Theatre
• Average length of stay
Planned Approach NOF
Management
• Stakeholders
• Project Development
• Trial Period
Initiatives implemented included:
Patient
Consultant
NOF Liaison
Database
Theatre
Consultant Involvement
Patient
Consultant
NOF Liaison
Database
Theatre
•Consultants
•NOF Team
•Monday to
Friday
Operating Theatre
Patient
Consultant
NOF Liaison
Database
Theatre
•Dedicated theatre
Monday to Friday
•6:30am start
•Benchmark
The Hip Fracture Database
Patient
Consultant
NOF Liaison
Database
Theatre
•Data
•Statistics
•Guide
practice
•Research
NOF Liaison Nurse
• 7 days per week
• Single point of contact
• Data collection
Patient
Consultant
NOF Liaison
Database
Theatre
NOF project trial results
• Decrease in time pt spent in ED
• Decrease in OT waiting times
• Decrease in average length of stay
NOF Project viable
Trial to now• Emergency board backlogged on Mondays
•Introduce Sunday Early Morning OT
• Early Morning NOF not starting at 6:30am
•Commence at 7:30am
• Daily rounds by Geriatric Registrar
• Weekly reviews by Geriatrician Consultant
•NOF nurse seven days per week
•Case Manager cover on weekends
•Routine urine MC&S collected in ED
•Monitoring for UTI
Fractured Neck of Femur AdmissionsSept 2006 – Sept 2012
Discharge Planning -
• Patient lives at home +/- with others
• Aim for discharge home or to PAH
Rehabilitation
• If going home expected d/c day 5 -7 post op
• If going to rehabilitation expected d/c day 4 or
5 post op
• Patient has private health cover
• Aim for private rehabilitation close to family
residence day 4 or 5
Discharge Planning -
• Patient lives in High Level Residential Aged
Care Facility
• If pt is medically stable
• Aim for discharge to HCNH day 3
post op
Discharge Planning -
• Early Ageing in place
• Transition from hostel - low care – high care
• Alternatives
• Queensland Health funded beds
• Interim Care
Streamlined
• Planning
• Processes in place
• Individual assessments
• Osteoporosis Treatment
• Communication
• Accessibility
• Goal focused
• Education
• Nursing, Doctors, Multidisciplinary
• Pt and family
Efficient
• Benchmarks
• Pt <4hrs in ED
• OT <48hrs and intervention at 30hrs
• Acute length of stay – 5 days
• Overall length of stay – 7days
• High Care Nursing Home – Day 3 post Op
• Rehabilitation Facility – Day 5
Efficient
• Accountability
• Accurate record keeping
• Report to executive quarterly
• Evidence based practice
Cost Effective
• Decreased length of stay
• Bed days saved
• Activity Based Funding
Streamline, Efficient, and
Cost Effective
PREVENTION!
Osteoporosis Nurse