REFLECTIONS ON HIP FRACTURE AUDIT

A GREGORIHAIRMYRES HOSPITAL

EAST KILBRIDE

STIRLING 27.11.2002

REFLECTIONS ON HIP FRACTURE

AUDIT

Oh shit another

boring audit talk

HIP # AUDIT

• Assesses whole process of # Care– A&E process– Admission process– Surgical Assessment and processing– Anaesthetic care and processing– Surgery– Post op and Rehab– Complications

HIP # SAHFE DATABASE

1997 Start Audit Introduce change

1998 Measure change

1999 Fine tune changes

2000 and on Audit service

AUDIT

• Continuous process

• Recognition

• Reaction

• Change

• Reassess

The Aim - Improve Quality of Care

Morbitity

Mortality

In Patient Stay

Dependance

The workers

Cost

Inefficiency

Bed Occupancy

The Managers

HIP # AUDIT

• IS CONTINUING AUDIT JUST BORING NUMBER CRUNCHING PROCESS ?

BENEFITS

• Basis for increased funding of # service

COOKING PHILOSOPHY

INGREDIENTS

Patients Audit Nurse

Resources Interested Clinicians

Use the SAHFE Cookboook

OR

Adlib??????

REFLECTIONS ON THE RECIPESHIP # AUDIT

=FOLLOW-UP

Process of Audit Data collection led to patient contact and a Clinical Care Opportunity.

SOWhat else can be done with this?

RECIPE No 1

Audit nurse follow up of all hip#

Routine # clinic review replaced by Audit nurse contact at 4 and 12 months

>400 return patient appts p.a.

in # Clinic

Replaced by 30 pat

returns p.a.

ROUTINE OPA/RECALLS

0

50

100

150

200

250

300

350

400

1998 1999 2000 2001

RecallsOPA

RECIPE No 2

Audit nurse arranging for physioRx

Identification of need may be only for PhysioRx

Ability for direct referral by Audit nurse

RECIPE No 3

Audit nurse actions clinic review

Consultant review of all clinic returns agreed

Point of contact for patients and GPs circumventing clinic referral letters and needless waits

RECIPE No 4

Physiotherapy falls prevention and education

Contact used to get greatest benefit

Multidisciplinary use of Data

RECIPE No 5

Osteoporosis Education

Targeting Osteoporosis Interventions

RECIPE No 6

QUALITY ISSUES AND QUALITY ENHANCEMENT

Written Notes

DVT Prophylaxis

Anaesthetic charts

CLINICAL INCIDENT REPORTING

AUDIT

• Continuous process• gets easier to do with

system in place

• gets harder

to improve

the subject

This is f#~*inghard work

UNEXPECTED DISHES

• Telephone review became a clinical tool - “someone cared”

• Encouraged multi-disciplinary communication

• Saved money!

• Clinical governance tool– teaching aid

WHY HAS THE AUDIT BEEN SUCH A LOCAL SUCCESS?

• Local ownership

• Proactive clinician

• On site analysis

• Reaction to ALL data

• Multi-disciplinary participation

• Development and closed the loop

DESSERTS

AUDIT SHOULD BE SEEN AS A CLINICAL CARE TOOL

CLINICIANS MUST BE INVOLVED TO MAKE IT WORK

12 MONTH FOLLOW-UP ESSENTIAL

THANKYOU

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