The Health Roundtable3-3a_HRT1215-Session_NEILSON_AUSTIN_VIC
Care of the Patient with a Fractured Neck of Femur
Presenter: Fiona NielsenHospital Austin
Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012
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KEY PROBLEMPolaris had a longer length of stay (36%) for DRG 108 than
exemplar health services. We could save a potential 700 bed days by matching exemplar health services.
ButWe all went to look at the care we were delivering to this particularly vulnerable group of patients. The clinicians and the executive, walked through the steps of patient’s journey to see for themselves. When we met together afterwards we all knew – we could do better than this:
Variable care deliveryInadequate and unmonitored pain reliefDelays to theatreProlonged and unmonitored fastingPeri operative complications - delirium
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AIM OF THIS INNOVATION
Provide quality care to this patient group, focus on what really matters.
Reduce variation in care delivery – ‘every patient, every time’.
Reduce variation in our systems –Patients to theatre within 48 hours
Manage fasting times- No patient to fast longer than 12 hours
All patients to have their pain managed and monitoredAll patients assessed and monitored for delirium
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BASELINE DATA-
Long length of stay
Long delays to theatre
and unclear plans led
to prolonged fasting
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KEY CHANGES IMPLEMENTED Hunger Clock.
Counts down patient
fasting time. 12 hour
tolerance – if the
patient does not have a
firm plan then the fast
is broken
Early
detection and
treatment of
delirium
Perioperative Pain
Plan.
All patients receive
full pain
management.
Patients
to theatre
within 48
hours
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OUTCOMES SO FAROutcomes July to December 2008 July to December 2011 2011- 2012
Bed Saving Days Potential 700 Actual 520 Actual 330Average Length of Stay 13.2 Days
36% Longer than 4 Exemplar
8.3 Days13% Shorter than all HRT
9.3 Days3% Shorter than all HRT average
In the dominant age group at Polaris-(80+)
ALOS 9.7 days – 7% shorter than all HRT ALOS at 10.5 days
Mode Length of Stay 9-11 days 3-5 Days 3-5 Days% Discharged Home ( not to other campuses or facilities
23% 30% 30%
% Emergency Readmission Rate
5.8% 1.9% 2.9% (34% lower than HRT average)
Relative Stay index 107% 60% 72%Average Age 79 Years 76 Years 77 Years
And Ongoing
Most patients
to theatre in
24 hrs, all
within 48 hrs
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LESSONS LEARNT
Stay the course, don’t listen to No
Consider the use of Failure Effects Analysis Mode, before final roll out of any
intervention
Clinical and executive leadership and support are essential, but support the
project lead and staff too.
Configure your Steering Committee and then have them delegate representatives
for you to work with
Excellence will do, perfection will burn you out
Hospitals are Frogs- not Bicycles.-Alistair Mant
Also
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