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 publish information to improve operational practices

– Promote collaboration and networking

Catalyst for NOF initiative was due to poor performance on HRT in 2006

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

•Benchmark

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

Theatre

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

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

Fractured Neck of Femur AdmissionsSept 2006 – Sept 2012

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

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

Discharge Planning -

• Early Ageing in place

• Transition from hostel - low care – high care

• Alternatives

• Queensland Health funded beds

• Interim Care

Streamlined

• Planning

• Processes in place

• Individual assessments

• Osteoporosis Treatment

• Communication

• Accessibility

• Goal focused

• Education

• Nursing, Doctors, Multidisciplinary

• Pt and family

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

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