The Health Roundtable FAST-NOF Fast, Appropriate, Safe Treatment for Fractured Neck of Femur Patients Presenter: Peter Mason Hospital QE2 Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct a_HRT1212-Session_MASON_QE_SA

The Health Roundtable KEY PROBLEM Prior to commencing changes Performance in DRG IO8 - # NOF emergency patients: HRT Custom Briefing CapellaHRT - 4 exemplar hospitals weighted average RSI121% 69% ALOS (most common principle procedure) Complication rate36%20% Average emergency surgery time lag (ED to Theatre) 1.6 daysN/A (2008-9) 2

The Health Roundtable AIM OF THIS INNOVATION  To decrease the ALOS for a patient with a # NOF in the acute care environment 3

The Health Roundtable BASELINE DATA What did this tell us? Our ALOS was high & not getting better Out of 12 similar sites in HRT, we ranked 10 th in RSI performance There were many barriers to prevent us achieving best practice #NOF procedures were deemed ‘low priority’ when compared to other surgical procedures 4

The Health Roundtable KEY CHANGES IMPLEMENTED  Developed a multi-D team from across the patient journey  Identified senior clinicians to be ‘Champions’  Reviewed literature to define best practice  Communicated with HRT exemplar units  Identified Takt time of work demand  Used Process Mapping to identify barriers  Developed standardised pathways that were developed & agreed upon by clinicians  Measured critical components of the pathway 5

The Health Roundtable KEY CHANGES IMPLEMENTED  Sought feedback from patients  Focussed on improving teamwork between the departments  Brought forward key activities to minimise delays  Met regularly (2 years later, we still meet & the team is even bigger!)  Fed back performance on a regular basis  Celebrated our wins  We made management of patients with a #NOF a core business of the hospital (MAKE NOFs SEXY!) 6

The Health Roundtable OUTCOMES SO FAR In the first 6 months of the project; ALOS ↓ 4.3 days, Time from ED to theatre ↓ to below best practice guidelines (24 hours) HRT data benchmarking; Av. Emerg. Surgery Lag =1.6 days =1.1 days Complication rate = 36% = 18% (HRT exemplars = 28%) Improvements have essentially been sustained 2 years later, we still meet monthly to address barriers Current goal is to create a seamless transition between acute & rehab 7

The Health Roundtable LESSONS LEARNT ‘Tell me, I’ll forget, show me, I may remember, but involve me and I’ll understand’ (Chinese Proverb)  Bring staff from across the patient journey together to address barriers to best practice  Follow an improvement methodology  Process mapping helps staff understand causation of problems  Understanding causation helps staff prioritise solutions  Meet & feedback performance regularly  There is no end point to improving the care of patients with a #NOF 8