Feeling Hip Again; Gold Standard Care for Hip Fracture Patients at St Vincent's Hospital
This project aims to improve the delivery of care to hip fracture patients at St Vincent's Hospital Sydney (SVHS). Standardisation of care processes will lead to improved patient flow, patient experience and staff satisfaction.
Aim
To provide gold standard care to every hip fracture patient by June 2020, with subgoals:
- Reduce average length of stay for hip fracture patients from nine to seven days, to be in line with peer benchmark hospitals by June 2020.
- Allow 85% of hip fracture patients to understand the discharge process and be included in the co-model of care by June 2020.
- Increase awareness of staff, by June 2020, of the post-operative process and discharge plan for hip fracture patients, from 40% to 100% by June 2020.
Benefits
- Impact on outcomes that matter to patients, including: patients knowing what to expect in hospital, feeling heard and safe.
- Providing evidence based care aligned to the hip fracture guidelines which, in turn, ensures patients are receiving safe and quality care.
- Decrease patient risk of hospital acquired complications (HACs) related to a prolonged admission, including: infection, pressure injuries and in hospital falls, which can then impact on patient's quality of life and mortality.
- Decreased penalties associated with hospital acquired complications (HACs) as a result of increased length of stay.
- Increase patient flow leading to increased bed capacity for surgical patients and ability to increase capacity for elective surgical beds.
- Increased utilisation of community services for hip fracture patients.
- Meet key performance indicators (KPls), both surgical and access.
- Improved staff satisfaction and reduced duplication of tasks.
- Increased partnership with rehabilitation stakeholders, both public and private.
- Increased performance and capability of staff.
- Gained staff expertise in the undertaking of clinical redesign and project management which will result in the ability to lead and coach others in future redesign projects.
Background
Under the Ministry of Health's (MoH) Leading Better Value Care (LBVC) programs, hip fracture management was identified as one of the key clinical initiatives in implementing an improved model of care to manage these patients.
As an organisation St Vincent's Hospital Sydney (SVHS) shares the same vision as the Ministry of Health (MoH) in providing value based care for our patients, and improving patient experience, outcomes and efficiency.
At St Vincent's Hospital Sydney (SVHS) in 2018, the hip fracture acute average length of stay (ALOS) was 10.73 days (2018 Australia and New Zealand Hip Fracture Registry (ANZHFR)), which was higher than the state ALOS and three days above peer benchmarked hospitals (Health Roundtable Data, 2018). A longer length of stay in the acute hospital leads to an increased risk of hospital acquired complications (HACs) including falls, pressure injures and infections. This impacts on our patients' morbidity, mortality and long-term quality of life. Further to this, by reducing the acute ALOS of leach hip fracture patient has the potential to save over 300 bed days per annum and reduce the cost of each admission substantially.
The patient journey and discharge process for hip fracture patients at St Vincent's Hospital demonstrated opportunities for improvement to standardise the patient journey and mitigate clinical variation. Clearly defining roles of the multi-disciplinary team, improving transfer timeframes to rehabilitation wards and alternative services and improving the communication of the expected hospital journey for the patient and their families were all identified as key priorities for the project.
Implementation
Project implementation was planned for early 2020, however the impact of Covid-19 has led to a delay in some of the deliverables being implemented. Subsequent staffing and ward changes to meet the potential surge meant that key clinical champions were deployed to other areas across the hospital. This heavily impacted the feasibility and effectiveness of the solutions previously developed and tested.
Original Implementation Plan (suspended early 2020 due to Covid-19 pandemic)
- Discharge huddle - aligned with executive initiative and currently in place. A preliminary audit was undertaken of the discharge huddles. A key measure of the huddle is the use of the Expected Date of Discharge (EDD) and Waiting for What that are data points on the Patient Flow Portal.
- Patient care boards - improved compliance and effectiveness.
- Fractured neck of femur clinical pathway - developed with all key stakeholders.
Revised implementation plan is due to recommence from October 2020.
Status
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Dates
Initiation: July/August 2019
Diagnostics: Sept/Oct 2019
Solutions: Oct/Nov 2019
Implementation: Feb 2020 - suspended. To recommence October 2020
Evaluation: April/May 2021
Implementation sites
Orthopaedic Ward (7 South), St Vincent's Hospital Sydney.
Partnerships
Agency for Clinical Innovation, Centre for Healthcare Redesign and University of Tasmania.
Evaluation
Measuring the impact on the patient's experience will be a key driver and measurement of success for the process. Ongoing monitoring of the ward specific net promotor score feedback and conducting qualitative interviews with patients will reveal ongoing success.
Monitoring of performance indicators including an improvement in acute length of stay, time to surgery within 24hours, compliance with patient flow portal and EDD use, as well as rates of hospital acquired complications will all be measures of success.
Evaluation of the staff experience and confidence in their knowledge of the care of hip fracture patients will be through the ongoing satisfaction survey.
Lessons learnt
- Robust risk management and engagement of champions leads to successful and effective solutions.
- Important to identify and engage all key stakeholders from the start.
- Take the time to deep dive in diagnostics and liaise with the right IT staff to assist in determining the source of truth for data.
References
Australia and New Zealand Hip Fracture Registry. (2018). Annual report for hip fracture care, NSW
Further reading
- Australia Commission on Safety and Quality in Health Care: Hip fracture clinical care standard. (2016)
- Ireland, A.W., Kelly, P.J. and Cumming, R.G. {2015). Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities. BMC Health Services Research. (pp.15 - 17)
Contact
Sarah Sweeney
Value Based Care and Innovation Manager
St Vincent's Health Network,
Phone: 0406 124 273
sarah.sweeney@svha.org.au
Emma Pauley
Senior Orthopaedic Physiotherapist
St Vincent's Hospital Sydney
Phone: 8382 3346
emma.pauley@svha.org.au
Alisia Verdejo
Musculoskeletal Coordinator
St Vincent's Hospital Sydney
Phone: 0474 904 965
alisia.verdejo@svha.org.au
