National Hip Fracture Database North West Regional Meeting 13th March 2013 Planning patient care and achieving Best Practice Tariff
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1 National Hip Fracture Database North West Regional Meeting 13th March 2013 Planning patient care and achieving Best Practice Tariff Dr John Tsang MB ChB, FRCP Consultant Orthogeriatrician Lead clinician Orthogeriatrics Service
2
3 If you or a loved one suffered a hip fracture, would you recommend your hospital?
4 Why hip fractures are so important Planning patient care Achieving BPT Top ten tips
5 Why hip fractures are so important rather be dead than admitted to a nursing home after a hip fracture 80% women over 75 yrs BMJ Feb ,000,000
6 Planning patient care
7 2008
8 2009 LEAN services Process mapping
9 Specialty Limb Reconstruction Mr. B. Narayan Mr. N. Giotakis Shoulder & Elbow Mr. M. Kent Mr. M. Smith Hand & Wrist Mr. D. Brown Mr. G. Cheung Pelvis & Acetabulum Mr. S. Kalra Mr. G. Kumar Hip & Knee Miss J. Banks Mr. B. Kapoor Foot & Ankle Mr. A. Roach Mr. C. Walker OG Dr J Tsang Dr H Cronin Trauma Co-ordinators Hip fracture practitioner Mrs H Haines Mr M Thompson Mrs M Nolan
10 Current services All hip fractures admitted under joint care Enhanced recovery pathway Daily consultant orthogeriatrician and orthopaedic surgeon WR s Daily consultant-led MDT -all hip fractures discussed Monthly multiprofessional hip fracture meeting Monthly trauma directorate meeting
11 Achieving BPT
12 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
13 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
14 BPT Surgery within 36 hrs RLUH National 50 40
15 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
16 BPT Joint care RLU
17 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
18 HIP FRACTURE MANDATORY REQUIREMENTS BY ADMITTING SHO or SPR 1. All patients must be clerked on the hip fracture pathway only (not A & E or continuation sheets)** 2. All patients must have pre-operative 10 point Abbreviated Mental Test Score (AMTS) ** 3. All patients should be prescribed IV paracetemol & Oramorph PRN as per analgesic algorithm unless contra-indicated 4. All patients admitted on Warfarin, give stat dose of IV Vitamin K 2mg and follow trust clinical guideline 5. All tests that may delay surgery must be done urgently 6. All patients should have VTE assessment and prescribe prophylactic Fragmin unless contra-indicated **including subtrochanteric fractures **including in-hospital hip fractures
19 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
20 BPT Perioperative medical assessments RLUH Apr - Oct 11 Nov - Apr 12 May - Jun 12 Jul - Oct 12 Nov - Jan 13
21 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
22 BPT Geriatrician-led MDT
23 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
24 Blue Book (std 5) Bone health assessment and treatment at discharge
25 Blue Book (std 6) Specialist falls assessment RLUH National
26 Best Practice Tariff 1. Time to surgery within 36 hrs 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics 4. Assessed by Geriatrician peri-operatively 5. Post-operative Geriatrician-led MDT rehab 6. Falls and bone health assessment 7. Two AMTS pre and post op
27 AMTS Apr-Jun 12 Jul-Sep 12 Oct-Dec 12 Pre-op Post-op
28 It s not all about the tariff Dementia care in orthopaedics Comprehensive cognitive screening Delirium management Nutritional support Fascia iliaca nerve blocks Hip fracture programme ESD Pre-op risk assessment Catheter pathway Continence assessment Bowel care pathway Specialist pharmacy education and medication review Information provision to primary care
29 Dementia care in orthopaedics
30 Hip Fracture Pathway Improvement in all areas Pre Post 0 Information Malnutrition
31 Nutrition in hip fractures
32 Early removal urinary catheters -HOUDINI B Pre Post 20 0
33 Top ten tips 1. LEAN services 2. Dedicated area for all hip fractures 3. Hip fractures 1 st on the list 4. Proactive work eg AMTS, mandatory requirements 5. Monthly multidisciplinary hip fracture meetings 6. Information provision monthly performance review 7. Non-clinical leadership -induction to trust board 8. Clinical leadership pre-operative to discharge 9. Supportive team/adequate resources audit department, specialist nurses, junior doctors, consultant colleagues 10.Not all about the tariff! develop other care aspects
34 Summary Collaborative work achieves high levels of best practice
35 If you or a loved one suffered a hip fracture, would you recommend the Royal? Yes!
36 Questions?
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