The Blacktown Local Government Area (LGA) has experienced considerable population growth from 2006-2022 (68%). This population growth is predicted to continue. The Blacktown Mount Druitt Hospital (BMDH) Fracture Clinic no longer meets the demands of the local community.
Recently, there has been a significant increase in Occasions of Service (OOS) across the clinic’s multi-disciplinary yeam (MDT) from 1744 per quarter in 2019 to 3018 in 2024. This equates to a 73% increase in OOS, which has resulted in longer wait times for patients, poor patient experience and staff dissatisfaction. Diagnostic information showed that there was a ‘bottle neck’ in patients waiting for orthopaedic review (average of 109 minutes) with a clinic sessional end-end time of 152 minutes. Most of this time was spent waiting, regardless of patient complexity.
The Western Sydney Local Health District (WSLHD) My Experience Matters (MEM) patient survey indicated that the low level of patient satisfaction was often due to waiting times. Furthermore, 78% of staff reported that working in the clinic is stressful.
Streamlined care at Blacktown Mount Druitt Hospital’s Fracture Clinic
This project looks to optimise and streamline care within the BMDH Fracture Clinic by delivering an effective and efficient service meeting the needs of the community, reducing time to care, and improving clinician and patient experience.
Benefits of the optimised service will include:
- improvement of access to care and patient flow, patient experience, and safety and quality culture (including the documentation of incidents).
- reduction in time off work or school for patients, competing demands on staff and decreased staff overtime costs, non-productive time for staff and physical waste (e.g. postage, paper, and stationary costs).
Applying a multidisciplinary approach
The solution design phase resulted in the following solutions being identified:
- The drafting of new Triage Guidelines and updating eReferrals into the BMDH Fracture Clinic.
- Formalising the triage process into clinic and developing inclusion and exclusion referral criteria
- Introducing an multidisciplinary team (MDT) approach and a new model of care (MoC).
- Creating clinical streams including an Orthopaedic Led Clinic, Physiotherapy Led Clinic, Physiotherapy Led Removals Clinic, MDT Wound Clinic and a Nursing Led Wound Clinic.
- Creating top of scope roles for physiotherapy and nursing (i.e. high-end scope of practice or professional competence) and renaming the clinic to BMDH Fracture & Orthopaedic Clinic.
- Developing a Did Not Attend (DNA) Policy to enhance patient communication and ensure vulnerable patients are managed appropriately.
- Updating patient information (e.g. webpage, information sheets) to provide guidance about accessing the clinic, logistics and medical care, and initiating MDT clinic communication pathways with a pre-clinic huddle to confirm patients for the day, and a MS teams chat during the clinic for patient updates.
Implementation has been achieved for all the clinical streams and there is an ongoing process to build capacity and patients numbers within each of the clinical streams.
Reduced demand on orthopaedics by 30%
The key measures for evaluation based on project goals include:
- reduction in waiting time for orthopaedics from 109 minutes to 45 minutes
- reduction in end-to-end sessional clinic time from 152 minutes to 100 minutes
- improvement of staff satisfaction from 39% to 65%
- reduction of staff stress levels from 78% to 45%
- improvement of patient satisfaction from meeting one benchmark to meeting 7 out of 13 benchmarks.
The initial results post-implementation indicate a reduction in waiting time for the Orthopaedic stream, reduced sessional end-to-end time for all patients in all clinics, and improved staff and patient experience. The updated MoC has resulted in fewer patients requiring orthopaedic review. Early results from the project include:
- a decrease in median end to end sessional time from 155 minutes to 125 minutes
- improved patient experience from meeting one MEM benchmark to achieving six benchmarks
- staff satisfaction improving from 39% to 78%.
Since the introduction of this approach, 30% of patients have been redirected into alternative clinical streams (e.g. Physiotherapy and Nursing) reducing the demand on the Orthopaedic stream. A comprehensive evaluation will occur in February 2025, six months post implementation.
View this project's poster from the Centre for Healthcare Redesign graduation November 2024.
