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 publ...
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
•Bench...
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
Th...
NOF project trial results
• Decrease in time pt spent in ED
• Decrease in OT waiting times
• Decrease in average length of...
Trial to now
• Emergency board backlogged on Mondays
•Introduce Sunday Early Morning OT
• Early Morning NOF not starting a...
Fractured Neck of Femur Admissions
Sept 2006 – Sept 2012
Discharge Planning -
• Patient lives at home +/- with others
• Aim for discharge home or to PAH
Rehabilitation
• If going ...
Discharge Planning -
• Patient lives in High Level Residential Aged
Care Facility
• If pt is medically stable
• Aim for di...
Discharge Planning -
• Early Ageing in place
• Transition from hostel - low care – high care
• Alternatives
• Queensland H...
Streamlined
• Planning
• Processes in place
• Individual assessments
• Osteoporosis Treatment
• Communication
• Accessibil...
Efficient
• Benchmarks
• Pt <4hrs in ED
• OT <48hrs and intervention at 30hrs
• Acute length of stay – 5 days
• Overall le...
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
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Fragility Fracture And The Hip: What Are The Key Elements Of Streamlined, Efficient And Cost Effective Evidence Based Hip Fracture Management

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Kate Bell, Osteoporosis Nurse, Princess Alexandra Hospital and Debra Long, Neck of Femur (NoF) Nurse, Princess Alexandra Hospital delivered this presentation at the 2012 Hip Fracture Management conference in Australia. The only regional event to discuss practical innovations and improvement processes for the management of hip fractures in the hospital setting. For more information on the annual conference, please visit the website: http://bit.ly/14lcuVY

Published in: Health & Medicine, Business
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Fragility Fracture And The Hip: What Are The Key Elements Of Streamlined, Efficient And Cost Effective Evidence Based Hip Fracture Management

  1. 1. Streamlined, efficient and cost effective care of the hip fracture patient Debra Long
  2. 2. Princess Alexandra Hospital
  3. 3. • 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
  4. 4. Areas of concern • Length of stay in ED • Time to Theatre • Average length of stay
  5. 5. Planned Approach NOF Management • Stakeholders • Project Development • Trial Period
  6. 6. Initiatives implemented included: Patient Consultant NOF Liaison Database Theatre
  7. 7. Consultant Involvement Patient Consultant NOF Liaison Database Theatre •Consultants •NOF Team •Monday to Friday
  8. 8. Operating Theatre Patient Consultant NOF Liaison Database Theatre •Dedicated theatre Monday to Friday •6:30am start •Benchmark
  9. 9. The Hip Fracture Database Patient Consultant NOF Liaison Database Theatre •Data •Statistics •Guide practice •Research
  10. 10. NOF Liaison Nurse • 7 days per week • Single point of contact • Data collection Patient Consultant NOF Liaison Database Theatre
  11. 11. 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
  12. 12. 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
  13. 13. Fractured Neck of Femur Admissions Sept 2006 – Sept 2012
  14. 14. 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
  15. 15. 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
  16. 16. Discharge Planning - • Early Ageing in place • Transition from hostel - low care – high care • Alternatives • Queensland Health funded beds • Interim Care
  17. 17. Streamlined • Planning • Processes in place • Individual assessments • Osteoporosis Treatment • Communication • Accessibility • Goal focused • Education • Nursing, Doctors, Multidisciplinary • Pt and family
  18. 18. 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
  19. 19. Efficient • Accountability • Accurate record keeping • Report to executive quarterly • Evidence based practice
  20. 20. Cost Effective • Decreased length of stay • Bed days saved • Activity Based Funding
  21. 21. Streamline, Efficient, and Cost Effective
  22. 22. PREVENTION! Osteoporosis Nurse

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