Date post: | 22-Jan-2018 |
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Good to Go: Partnering with Patients & Families to Improve the
Experience of Going Home After Hip Fracture
1130-1230 on Thursday, February 25, 2016
B4 | HIP Hop Don't Drop: Three Stories Highlighting HIPstars
Disclosure Slide
• This project was funded by the
Canadian Foundation for Healthcare Improvement as part of the Canadian collaborative
“Partnering with Patients and Families for Quality Improvement”
Why this project? • Approximately 4,000 British Columbians
have a hip fracture each year.
• 22% will be back in hospital within 90 days
Patient experience can be improved… We can do better!
‘Well, one of the things that’s interested me, and I’ve been too stupid to ask…… I know the incision’s on the side of my leg. But nobody’s ever told me, you know, shown me a picture of my hip and said, this is where it got fractured, or this is where your leg is fractured.’
From : Heeding the Patients
Voice in Post-Hip Fracture Care
Transitions Sims-Gould, J.¹, Byrne, K.²,
MacDonald, V. ³, Carr, M.³, Hicks, E.¹, Khan, K.¹, & Stolee, P
“I was given a handful of pills- I said “which one of these is my heart medication? She (nurse) said ‘It doesn’t matter- you need to take them all anyway’ Ellen, 79
From our baseline qualitative data
@CFHI_FCASS cfhi-fcass.ca |
Project Aim Statement
What will improve: the patient experience of the transition home.
For whom: Hip fracture patients >age 65 years, returning to the community, after surgery for hip fracture
By when: September 2015
By how much: 10%
@CFHI_FCASS cfhi-fcass.ca |
How did we measure patient experience?
@CFHI_FCASS cfhi-fcass.ca |
What quantitative and qualitative data were gathered?
Stories, Surveys and Shadowing
2 Focus groups, 24 In depth interviews, 60 HCP surveys, ~ 90 patient surveys, field observation
How did we use this data to drive change? Regular staff meetings to review data, identify improvement opportunities and plan tests of
change.
PDSAs We tried What worked!! What didn’t!!
Fresh Start – reviewed daily by team & personalized for patient.
Giving Fresh Start to read with out ongoing personalized review.
Proactive bedside meetings with family/team.
Group classes – labour intensive and each person needed their own!!
Assigned staff person to support family with transition.
No one accountable for engaging patient/family for transition.
Focused home follow up phone call & visit using FS. Pilot Study at Surrey Newton
Pharmacist meeting in hospital and follow up phone call
Leaving them to flounder at home. Many don’t recall teaching.
Unanticipated problems arise with medications AFTER discharge.
@CFHI_FCASS cfhi-fcass.ca |
One PDSA cycle: pharmacist visit in hospital, and a phone call after discharge
A certain subset of patients do not recall any discharge teaching (e.g. cognition, confusion, being overwhelmed)…
“Some things come up, only after discharge, such as: trouble sleeping, change of dose of a previous home medication, side effects of new medications;
These things may not necessarily be a concern in hospital, or patients may not be aware of them until they get home”
Pharmacist
@CFHI_FCASS cfhi-fcass.ca |
What Process Measures did we track?
@CFHI_FCASS cfhi-fcass.ca |
Delivery Of Education
Fr actur e Recovery for Seniors at Home:
A hip fr actur e r ecover y guide for pat ients & famil ies
http://www.hiphealth.ca/blog/FReSHStart
Toolkit for Recovery Your fracture/surgery Prevent risks e.g. delirium, UTI How/where to meet needs for home support & equipment Home safety/fall prevention Red flags & what to do Medication safety Follow ups: e.g. medical, bone health, exercise Exercises
@CFHI_FCASS cfhi-fcass.ca |
What assumptions did we make?
That data collection
would be straightforward……
BUT….
Staff training is required,…
staff turnover occurs
AND
Our target population are frail, and can be challenging to recruit
@CFHI_FCASS cfhi-fcass.ca |
Key Results: What Happened to patient experience?
N= 58/150 patients ~ 40% response rate
20%
@CFHI_FCASS cfhi-fcass.ca |
Staff turnover, staff training , (at one site , we had difficulties with the data collection – patient measures were incomplete)
Organizational re-structuring, changes in leadership for both organizations- a constant state of flux
Competing priorities / initiatives
Person dependent effect – scores dip when key staff are away– Champions and key staff assigned to this work are key for sustainability.
REQUIRES A SUSTAINED EFFORT TO SHIFT CULTURE:
CARE TRANSITION SUPPORT IS NOT A FRILL. IT IS VITAL!!
Challenges
@CFHI_FCASS cfhi-fcass.ca |
What are we most proud of ?
Rapid communication across 2 Health Authorities, to learn from
each other’s mistakes and implement each other’s successes
Alignment with Accreditation Canada’s “Focus on transitions” report: ensuring evidence based
and rigorous
background knowledge and research to inform our priorities
Supports the Vision and Values of our Organization’s strategic plan,
to improve the patient and caregiver experience
Engaging the energy, commitment and enthusiasm of key clinical champions from both
health Authorities , across the transitions of care
( acute, rehab, community)
Partnering with the BC Ministry of Health Hip Fracture Redesign QI project for data collection and
dissemination of findings
Using the data, and the patient and caregivers voices to inspire our teams and drive improvements
@CFHI_FCASS cfhi-fcass.ca |
What was our most significant lesson learned?
“Patient experience is more than lip service…It can drive improvements in care!
“If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it” Leonard Kish
Thoughts…
• Have you had success in sustaining similar projects?
• What strategies and tips did you use?
@CFHI_FCASS cfhi-fcass.ca |
Thank you! Questions?
Dolores Langford Valerie MacDonald [email protected] [email protected]