Improving Outcomes For Hip Fracture Patients With Multiple Medical Problems In A Surgical Ward Environment

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Sue Parslow, Grade 4 Physiotherapist, Box Hill Hospital Eastern Health 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

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Improving Outcomes For Hip Fracture Patients With Multiple Medical Problems In A Surgical Ward Environment

  1. 1. Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Hip Fracture Conference December 3-4 2012 Improving Outcomes for Hip Fracture Patients with Multiple Medical problems in a Surgical Ward Environment Sue Parslow Grade 4 Physiotherapist – Site Operations Box Hill Hospital Eastern Health
  2. 2. Eastern Health People living in the east who are over 70 years of age will be the most frequent users of our service by 2022. In 2009-10, Eastern Health admitted almost 30,000 people over the age of 70 years (excluding dialysis) and each patient stayed, on average, over 3 days longer in hospital than those aged under 70 years of age. Whilst the number of patients over 70 years of age represented 27% of all patients, they represented 45% of all inpatient ‘bed days’ or days spent in hospital. It is imperative that elder-friendly services and environments permeate throughout the breadth and depth of Eastern Health.
  3. 3. Eastern Health • Eastern Health provides a comprehensive range of high quality acute, sub- acute, palliative care, mental health, drug and alcohol, residential care and community health services to people and communities that are diverse in culture, age, socioeconomic status, population and healthcare needs. • We deliver clinical services to more than 750,000 people through seven Clinical Programs from more than twenty-nine different locations. • Our services are located across 2800 square kilometres in the east - the largest geographical catchment area of any metropolitan health service in Victoria. • We employ over 8 300 people, deliver more than 800,000 episodes of patient care
  4. 4. Eastern Health Sites • Hospitals (7) • Angliss Hospital
Box Hill Hospital
Healesville & District Hospital Maroondah Hospital
Peter James Centre Wantirna Health
Yarra Ranges Health. • Residential care facilities (4) • Community-based facilities • Multiple community-based rehabilitation and transition care facilities. • Mental health facilities (7) • Community health service (1) • Statewide services (2) • Spectrum Borderline Personality Disorder Service Turning Point Alcohol & Drug Centre.
  5. 5. Our services to the community • Hospital care: 140,743 patients admitted to hospital for acute care • Emergency: 141,251 patients treated in our three emergency departments. • Ambulance arrivals: 35,959 ambulance arrivals at our three emergency departments. • Surgical operations: 29,471 operations performed. • Outpatient services: 169,992 people received care as outpatients • Births: 4577 babies delivered. • Children: 11,849 people aged under 18 admitted to our hospitals. • Sub-acute ambulatory care services (SACS): 65,904 occasions of service for our sub-acute care clients.
  6. 6. Our Services to the Community • Sub-acute hospital care: 3728 people admitted to one of our sub-acute facilities. • Eastern@Home: 2560 patient separations.
Hospital Admission Risk Program (HARP): 4167 patient separations • Post-acute care (PAC): 4035 patient separations. • Mental health community services: 153,375 occasions of service delivered in our community. • Mental health hospital care: 2796 people admitted to one of our mental health inpatient facilities. • Community health: 28,950 hours of community-based healthcare provided to our
  7. 7. Population • Meeting the needs of an ageing population in the east, where the number of those who are over 70 years of age is growing more quickly than the rest of Melbourne.
  8. 8. Looking after Hip Fracture Patients at Box Hill Hospital • 30 Bed Surgical Unit • Patient mix includes Orthopaedics, Plastics, ENT,Gynae, Surg and Vascular • Orthopaedics activity is the same as when only a Ortho and Plastics ward
  9. 9. The Orthopaedic Ward Team • Orthopaedic Service Consultants 10-12 Registrars -3 HMOs -4 Outpatient Clinics 2/week Consultant Ward Rounds 2/week Daily Orthopaedic Registrar Ward Rounds Operating lists am and pm most days
  10. 10. Daily Orthopaedic Registrar Ward Rounds • Held every am Monday – Saturday • All registrars and HMOs attend • Nursing and Physiotherapist attend all these ward rounds • Clear feedback regarding post-op orders and difficulties with some orders esp. Weight bearing • Opportunity to discuss discharge planning • Determining if patients ready for discharge/transfer from orthopaedic perspective
  11. 11. Daily Ward Team Meeting • Nursing Led • Allied Health in attendance • Includes Physio, OT, SW • Ambulatory Representative – manages referrals for Eastern@home, PAC, RDNS, Inreach
  12. 12. Orthogeriatric Medical Service • Well established since 2003 • The primary aim of the service is to assist in the provision of High Quality and effective care to elderly patients admitted to BHH with major fracture requiring orthopaedic intervention who have multiple co-morbities
  13. 13. Orthogeriatric Medical Service • Assists with the provision of acute assessment and management of medical problems in this cohort • Also the elective Orthopaedic patients who have significant medical co-morbities
  14. 14. Orthogeriatric Medical Service • Orthogeriatric Consultant Ward Rounds- Monday and Thursday includes nursing and physio • Orthogeriatric registrar Daily rounds with HMO on ward service • Consultant and registrar attends ortho consultant X-Ray meeting and WR
  15. 15. Key Elements • Monitoring and re-evaluating the effectiveness of post- operative analgesics in association with the APS as appropriate • Early identification and treatment of perioperative morbidity especially delerium • Thrombo-embolic prophlaxis as approriate • Early identification of discharge destination for the post acute episode • Timely discharge when acute issuesare stable
  16. 16. Integration of these services • Daily 7.30am Ward Round • Daily Team Meeting 8.45am Mon-Fri !! • Daily Orthogeri registrar rounds • Consultant rounds
  17. 17. Daily Team Meeting • Handover • Discharge Planning • Allocation of tasks related to the patient care, finding of information, involvement with family • Sourcing other services and referrals • Journey Boards completed post meeting
  18. 18. Discharge Planning • Referrals for inpatient subacute beds completed by Nursing and Physio staff • Usually sent to Access unit day 1/2 postop • Elective referrals are completed at pre- admission and faxed once patient admitted • Beds available day 3 postop • Ortho geri registrar determines if medically ready • Ortho ready determined by am WR
  19. 19. So how are we doing ? 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% BHH ORT1 BHH ORT2 MH ORTH EH RSI I03
  20. 20. So how are we doing ? 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% BHH ORT1 BHH ORT2 MH ORTH EH RSI I08
  21. 21. Future • New Hospital end of 2014 • Orthopaedic ward only once again • Subacute ward on site • New models of care • < 4 hour stay in ED • Pull model from ED • Patient in ward before confirmation of diagnosis
  22. 22. Acknowledgements • Helga Ploschke - NUM • Tracey Khan - Physiotherapist • Dr Chris Fong – Orthogeriatric Consultant

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