Back row: Prem Kumar, Ian Dodson, Jennifer Baker, Noelene Chetty, Terri Killip
Front row: Beverley Saward, Danielle Farrel
Absent from the photo:Kathy Walker and Rosie Whittington
The Hip Fracture Care Team was purpose built for the 20,000 Days Campaign Collaborative, with a focus on improving the journey and care for hip fracture patients at Middlemore Hospital.
Approximately 225-250 patients fracture their hip every year, with nearly all-undergoing surgery to repair the fractured hip and staying on average 22 days. These patients can be quite sick with a number of co-morbidities putting them at high risk of other complications. They also have a mortality rate of around 30% within 12 months of their fracture.
Our early project work looked at the current system of care, with a particular focus on the patient journey after surgery. More than half of hip fracture patients move from orthopaedics to Assessment Treatment and Rehabilitation (AT&R) for rehabilitation during their stay and have to negotiate a move between services that is enough to give the Transitions of Care collaborative many sleepless nights. The busy winter had quite an impact and the transition between services, with increasing demands on bed capacity was a persistent issue.
A key intervention that we implemented early on was a trial of 7-day physiotherapy rehabilitation, which is nearing its third month of testing at full scale. 7-day physiotherapy rehabilitation is a recommended best practice for hip fracture patients and ensures they are actively working on recovery of mobility 7 days a week. A key issue with the trial has been reliably determining its effectiveness in a short-term, small-scale trial. The learning here was to spend more time in early testing to get a responsive enough measure to determine the effectiveness.
We are also developing and testing some change ideas around patient information and satisfaction, discharge and transfer guidelines and a review of the early transfer protocol from Orthopaedics to Ward 4
In the New Year we will start looking at the pre-surgical journey, as the time taken to reach theatre has a critical impact on the hip fracture group. Research shows that for every 8 hours, over 36 hours, that a patient waits for surgery they will spend an additional day in Hospital.
Our small team consists of Kathy Walker, Jennifer Baker, Noelene Chetty, Rosie Whittington, Prem Kumar, Danielle Farrell and more recently Beverley Saward. The amount of work required from a small team has been challenging, particularly when the day job takes over, however we have enjoyed the robust debates and have become quite good at making quick decisions, allowing us to spend more time testing our ideas. We have also been fortunate to have Brandon Bennett, Improvement Advisor from Improvement Science Consulting, checking in on our progress and instilling his words of wisdom.
I can say with confidence that the IHI Improvement methodology has become embedded in our psyche and the PDSA (Plan-Do-Study-Act) cycle etched into our brains.
The IHI methodology itself is simple in concept but does take some discipline to apply it properly. What we did learn early on was to apply the PDSA cycle to small learning cycles as opposed to big learning cycles that would run for a few weeks and fail to provide a meaningful outcome.
My parting words of wisdom would be to fail small, fail quickly and fail often but make sure you learn along the way.
The Hip Fracture Care Team
20,000 Days Campaign