Leading Better Value Care
Local vignette – St Vincent’s Hospital Network

Hip fracture care

Timing to surgery – a clinician's perspective

By Dr John Rooney and Emma Pauley

27 Apr 2021 Reading time approximately

What is important to know about your service?

St Vincent’s Hospital Sydney is a full service acute public teaching hospital with a trauma centre. The metropolitan hospital has 379 beds and sees more than 150 patients with hip fracture injuries annually. The orthopaedic team perform both trauma and elective lists each day.

What organisational model do you use?

Rapid access to theatre and improving time to surgery for hip fracture patients.

Pain management
leads to
Timing of surgery
leads to
Orthogeriatric principle of care
leads to
Mobilisation and weight bearing

What is special about the way care is delivered that is valuable for others to know?

The orthopaedic department conducted a review of the surgery process to create efficiencies in theatre allocation, improvement in patient flow and decreasing the time hip fracture patients waited for access to surgery. The ultimate goal was to meet the 24-hours to surgery target, which is best practice for this patient cohort.

Previously, there was one room with elective surgery in the morning followed by emergency trauma list in the afternoon. Due to the changing demand of trauma patients, hip fracture patients often had to be re-prioritised to the next day, impacting on patient safety, patient flow and increased bed day costs per patient.

As a result the team decided to split the two lists, elective surgery remaining in the morning at half a day, whilst there is a full day trauma list in a separate theatre. The modification of theatre time and space enabled greater utilisation of resources and increased access for hip fracture patients.

How was this done?

To justify the increased amount of theatre time, the orthopaedic department reviewed the management of patients requiring surgery following a wrist, ankle and clavicle fracture. For those patients who were safe to do so, they are discharged home and return the following day for planned surgery. This not only assisted in theatre allocation planning, but the bed day savings as a result of this change funded the added theatre list time.

A large part of this change was the monitoring of the time to surgery. The senior registrar is responsible for reporting weekly data to the head of the orthopaedic department and these results are shared with the multidisciplinary team.

A companion document describes options for organisational models in Hip Fracture Care. One option is rapid access to theatre – this vignette describes the model from a local perspective.

How does it make a difference?

Emergency orthopaedic patients and specifically hip fracture patients, have increased access to surgery leading to time to surgery targets being consistently met, improving both clinician and patient experience, reducing family anxiety about theatre times being delayed.

Further to this, reducing the time to theatre decreases the risk of the patient developing post-op delirium, complications with fasting and enables better pain management.

What tips do you have for others?

  • Gain support from the operation stream manager, head of orthopaedic department, executive directors and theatre management team.
  • Understand the surgical operational process as a whole to identify opportunities to improve patient flow and theatre efficiency.
  • Work closely with the finance department to optimise activity, improve patient flow and therefore improve hospital revenues.
  • Monitoring and tracking of the data, reviewed monthly to maintain vigilance and sustainability.

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