ran parallel with the implementation to ensure rapidfeedback on usability and potential improvements.

The ticket home system commenced 1.8.08 fol-lowing 48 h of design and implementation. Figuresproduced within the trust were used to measurethe impact of the ticket home. Before the tickethome the average LOS for total hip replacementpatients was 6.2 days, 2 months following theimplementation of the process the average LOShad fallen by 19% to 5 days. Data collected at wardlevel identified in September 2008, 56% of total hipreplacement patients achieved their PDD, followedby 70% in October, 65% in November, and 86% inDecember.

Intended learning outcomes:

� Raising patient and multidisciplinary staffawareness of their PDD will reduce their LOS.� Visual systems of communication have moreimpact.� The more simple the system the more effec-tively it will be implemented.� Better information for planning bed capacity.� Fewer logistical issues for staff as discharge ispre planned.

Recommended reading:Department of Health, 2004. Achieving timely

simple discharge from hospital; a toolkit for themultidisciplinary team. DoH, London.

National Audit Office, 2000. Hip replacements,getting it right first time. NHS executive, London.

NHS Insititute for Innovation and Improvement,2006. Delivering quality and value – focus on: pri-mary hip and knee replacement.

Tierney, A., Closs, J., 1993, An evaluation ofhospital discharge. Nursing Times 89 (47), 11–12.

Welsh Assembly government, 2004. An ortho-paedic plan for Wales – Getting Wales moving.WAG. Cardiff.

doi:10.1016/j.joon.2009.07.041

National Hip Fracture Database: One year on.Personal experiences of using the database(Poster)Margaret Russell, Terrence Kelly

Manchester Royal Infirmary, UK

Aim: To demonstrate how audit can improvecare for older patients with fractured neck offemur.

Abstract: Over 300,000 patients are admittedto hospitals in the United Kingdom annually with

hip fractures and this number is set to rise asthe population gets older. With this in mind, TheNational hip fracture database was launched inSeptember 2007 a joint initiative with the BritishOrthopaedic Association (BOA) and the BritishGeriatric Society (BGS). Currently over 100 hospi-tals in England are collecting data using an audittool designed by the BOA/BGS. It is anticipatedthe all hospitals with trauma units in England willcollect data on hip fractures. Data collected willprovide an abundance of information on hip frac-tures which will be analysed for each individualhospital and also at national level. This will formthe basis for development of a gold standard bestpractice guidelines and standards for hip fracturepatients.

Continuous comparative data will provide anincentive to sustain improvements in standardsand cost effectiveness. The database aims to auditand benchmark to the six standards identified asbest practice in the BOA publication (2007). Expe-rience and results at a North West of Englandteaching hospital are already showing valuableinformation and action plans are now in the processof development to further improve the service forolder people with broken bones.

This poster presentation will demonstrate howpractice is improving and make reference the per-sonal experiences of the data collectors and coor-dinators of the National Hip Fracture Database ata hospital in North West England.

Intended learning outcomes:

� Demonstrate how audit can aid good practiceand enable change in practice to occur.� Identify areas of good practice and also the gapsin the care of hip fracture patients.� Increase local and national knowledge base onevidenced based care of patient’s with hipfractures.� Identify some of the challenges involved in join-ing the database and the continuing the datacollection.

Recommended reading:British Orthopaedic Association, 2007. The care

of patients with fragility fractures. BOA, London.

doi:10.1016/j.joon.2009.07.042

Reducing mortality in hip fracture patients(Poster)Claire Bailey, Julie Pilkington

Royal Bolton Hospital NHS Foundation Trust, UK

152 Abstracts

Aim: The aim of this poster is to describe howthe reorganisation of clinical services can have apositive impact on hip fracture mortality.

Abstract: In 2005, Bolton Hospitals journey ofimprovement began using ‘lean’ in healthcare. Acause for concern was the link between Institutefor Healthcare Improvement’s (IHI) ‘‘100k LivesCampaign’’, and Bolton’s high mortality in hip frac-ture patients. The trust focused on reducing mor-tality associated with hip fractures, developing aTrauma Stabilisation Unit (TSU).

Problem: In 2004/05, the SMR for hip fracturepatients was 173.9 – the expected level of mortal-ity across the NHS is 100.

Analysis of problem and causes: Traditionalhealthcare approaches to reducing mortality hadfailed to succeed. The Orthopaedic team mappedthe pathway and discovered significant problemsandpotential for error in pre andpostoperative care.

Strategy for change: The team re-designed thepathway to ensure patients and information could flowwith no delays. A 6 bed TSU was established providingquality and standardised care for patients with com-plex needs. The unit is supported by a full time Consul-tant Orthogeriatrician and multidisciplinary team.

Effects of changes: The data shows reduction inmortality – 15% better than national average –about 140 fewer deaths than if we had continuedon the same path.

Lessons/Messages learnt: Mortality can be af-fected when existing systems and practices aresubject to scrutiny using ‘lean’. Improvements inmortality can and must be made and this unithas, and will continue to save lives.

‘Lean’ provides a powerful way to evaluateproblems in existing services. A thorough under-standing of the problems encountered when reor-ganising care for patients. Hip fracture Mortalitycan be drastically reduced using ‘Lean’ methods.

Recommended reading:Khan, R., Fernandez, C., Kashifl, F., Shedden, R.,

Diggory, P., 2002. Combined Orthogeriatric care inthe management of hip fractures:a prospectivestudy. Ann. R. Coll. Surg. Engl. 84(2), 122–124.

British Orthopaedic Association, 2007. The careof patients with fragility fractures. BOA, London.

doi:10.1016/j.joon.2009.07.043

Comprehensive Optimisation of Patients needingSurgery (COPS) – A multidisciplinary service forolder or complex elective orthopaedic surgicalpatients (Poster)

Elizabeth Patel, Anna Carrerky

Royal Bolton Hospitals NHS Foundation Trust, UK

Aim: This paper describes how a proactive multidisciplinary team approach to the care of complexelective orthopaedic patients can have significantbenefits.

Abstract: Between 01/09/07 and 30/11/07, wepiloted a multidisciplinary proactive team ap-proach to the management of elective orthopae-dic surgical patients at Bolton Hospitals NHSTrust. Older patients, all with complex medical,therapy and social issues were selected. The teamincludes a consultant geriatrician, nurse specialist,occupational therapist, physiotherapist and socialworker.

Problem: Adverse post-operative outcomes andprolonged length of stay following surgery, aremore common in older people. At Bolton Hospi-tal, patients undergoing elective orthopaedic sur-gery in hip and or knee replacement had a longerlength of stay.

Analysis of Problem: Prior to COPS, specialistmedical consultation was at the discretion of theorthopaedic team. Delays were encountered as so-cial and functional difficulties came to light oncethe patient had been admitted to hospital.

Strategy for change: Patients aged over 75years, regardless of the co-existence of co-morbidconditions were referred to the COPS team. Carewas coordinated by an Orthogeriatrician. Impor-tantly a proactive approach was taken by the ther-apy and social work team members to predict postdischarge needs prior to admission and have careand equipment in place.

Effects of changes: The collaboration betweenCOPS and the orthopaedic team has created atightly integrated multidisciplinary partnershipwith improvement in continuity of care.

Key messages: By organising clinical services inthis way Length of stay and clinical outcomes canbe significantly improved. This approach is feasiblefor wider NHS implementation as it provides moreefficient and effective care for older elective surgi-cal patients.

Recommended reading:Harari, D., Hopper, A., Dhesi, J., Babic-Illman,

G., Lockwood, L., Finbarr Martin, F., 2007. Proac-tive care of older people undergoing surgery(‘POPS’): designing, embedding, evaluating andfunding a comprehensive geriatric assessment ser-vice for older elective surgical patients. Age andAgeing 36(2),190–196.

Selected abstracts from the 23rd Royal College of Nursing Society 153