The Health Roundtable Improving Patient Flow in Orthopaedic Inpatients Presenter: Kathy Flanigan - Nursing Director Hospital QE11 – Vic Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct b_ HRT1215-Session_FLANNIGAN_QE2_VIC

The Health Roundtable KEY PROBLEM  Orthopaedic patients experiencing a longer than average length of stay (LOS) when compared to peer groups.  Primary knee arthroplasty had an average LOS of 6.7 days.  Primary hip arthroplasty had an average LOS of 8.1 days.  Observation of outcomes in terms of LOS, weekend discharges, discharges before 10am were made and strategies proposed to make treatment more efficient. 2

The Health Roundtable AIM OF THIS INNOVATION  Improved communication between health care professionals is essential for enhanced patient care.  Decreased average LOS for knee arthroplasty.  Decreased average LOS for hip arthroplasty. 3

The Health Roundtable BASELINE DATA  Primary knee arthroplasty had an average LOS of 6.7 days.  Primary hip arthroplasty had an average LOS of 8.1 days. 4

The Health Roundtable KEY CHANGES IMPLEMENTED  Improved preadmission assessment (for discharge planning).  Day of admission assessment for discharge.  Defined discharge facilitator role.  Introduction of Estimated Date of Discharge. 5

The Health Roundtable KEY CHANGES IMPLEMENTED  Revised ward round process.  Quarantined time for orthopaedic, post operative X-Ray of patient.  Formal, in-reach rehabilitation service in orthopaedic ward.  In-reach opportunities and capacity of the Hospital in the Home (HITH) service. 6

The Health Roundtable OUTCOMES SO FAR 7

The Health Roundtable OUTCOMES SO FAR 8

The Health Roundtable OUTCOMES SO FAR 9

The Health Roundtable OUTCOMES SO FAR 10

The Health Roundtable LESSONS LEARNT  The ‘Board Rounds’ were a low cost and easy change to implement. The result in each measured data set show a significant improvement. There was an increase in weekend discharges – a result of better communication.  The LOS for the top 5 DRGs were improved.  In particular LOS was reduced from 6.7 days to 4.29 days for primary knee arthroplasty and from 8.1 days to 4.57 days for primary hip arthroplasty.  The LOS was reduced when compared to both our previous average and the average LOS for our peer group hospitals. 11