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  • Hip fracture quality improvement case study

    Issue

    Hip fractures are one of the most common and serious injuries in older people and can be fatal. 177 hospitals admitted 65,958 people with a fractured hip the UK during 2015.

    Overall one year mortality was high at 30% and survivors faced decreased function – 33% needed more care and support and a fifth of patients didn’t return to their own home.

    The care pathway was complex and the cost of care high – and set to rise sharply as the population continues to age. 1 in 3 people wait more than 2 days for surgery and there is often a prolonged length of hospital stay.

    Solution

    High quality, safe care required the coordinated effort of a multidisciplinary team committed to evidence based and person-centred care.

    HIP QIP (Hip Quality Improvement Programme) was initiated to improve outcomes following hip fracture.  HIP QIP was led by Northumbria Healthcare NHS Foundation Trust (Northumbria) in partnership with the British Orthopaedic Association and Academic Health Science Network for the North East and Cumbria, with evaluation by the Royal College of Physicians. HIP QIP aimed to improve care for hip fracture patients via a multidisciplinary pathway:

    • Quicker access to surgery;
    • Establishing a multi-disciplinary team including specialist nutritionists and ortho-geriatricians, a HIP QIP Steering Group with physicians, patients, and volunteers and a multidisciplinary audit framework;
    • Rehabilitation standards including fast patient mobilisation post operatively;
    • Prioritising additional nutrition for patients;
    • Implementing a surgical care bundle, pain block in ED and surgery within 36 hours;
    • Focus on patient experience;
    • Root cause analysis of any deaths;
    • Measuring outcomes and using data transparently and publically;
    • Strong leadership; and
    • Culture of continual improvement and change management.

    Outcomes

    • Faster access to information, imaging and surgery – 90% of patients now receiving their surgery in 36 hours – the best rate in the UK;
    • Better pain management – 97% of patients interviewed believed all that could be done to control pain was done;
    • Improved nutrition – 80% of patients now receive additional feeding each day;
    • Early physiotherapy 7 days a week – including faster mobilisation – 100% of medically fit patients mobilised day 1 post operatively, and 25% on day 0 (previously 4%);
    • Reduced incidence of surgery site infection (down 68%);
    • Statistically significantly improved mortality – lower than UK average – with a 31% reduction in 30 day mortality;
    • Reduced average length of stay from 30 days to 20 days;
    • Improved patient quality of life; and
    • Improved income and reduced costs.

    “We are so proud that our HIP QIP is being adopted by other trusts to support the Scaling Up Improvement Programme which is really making a difference to patients across the NHS.”

     –  Annie Laverty, Chief Experience Officer

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