Northumbria Healthcare’s HIP QIP .
Person centred care after hip fracture.
Why HIP QIP ?
• Common and serious. • Mortality is high at around 30%.
• 1 in 3 people will wait more than 2 days for surgery. • Prolonged hospital stay. • 33% need more care support • 1 in 5 people wont return home.
What we needed to do.
• Provide hip fracture care of the highest quality.
• Adopt a pathway approach to ensure consistency of care.
• Ensure recent evidence and national standards are systematically implemented.
• Provide exceptional patient experience – meeting physical, emotional and information needs.
Making it happen.
• HIP QIP Steering Group.
• Multidisciplinary membership :
– Key clinicians representing all parts of the patients’
pathway.
– Executive management team involvement.
– Voluntary sector – CEO : Age UK.
NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST
Fractured Neck of Femur Quality Improvement Project.
How has it made a difference ?
Safe and effective care.
Deaths on NHFD since Oct 09.
0
5
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30
O N D J F M A M J J A S O N D J F M A M
Month of admission
%
WGH NTGH Trust
Trustwide 30 day mortality has improved from 14.3 % to 9.8.%. This is a 31 % reduction.
Best in class - timely surgery.
• National average 61.5% (range 9% to 88%)
• Wansbeck best in NHS for 36 hours at 88%.
• North Tyneside best in NHS for 48 hours, operating on 99.6% of patients in this timeframe.
• Trust performance consistently maintained at 90% mark.
Providing safe and effective care.
0
10
20
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100
Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Arp 11 May-11 Jun-11
BPT NORTHUMBRIA
BPT NATIONAL
BEST PRACTICE TARIFF – BPT 2010/11
Co-ordination and integration.
• surgical care bundle
• rehab standards
• early mobilisation – 25%
• timely involvement of orthogeriatrician
• mutidisciplinary audit framework
Measuring outcomes. Weekly:
• Additional nutrition for patients • Best Practice Tariff • Surgical Care Bundle Compliance Fortnightly: • Patient experience Monthly: our Quality Account • Time to x ray • Mortality Rates • Pain blocks • Early Mobilisation • Infections and pressure sores • Home to Home rate
Physical comfort.
80% of patients receive a nerve block on admission
97% of patients interviewed believed we did everything we could to effectively control pain. (n= 384)
80% of patients now receive additional feeding each day, with the help of nutrition assistants and volunteers.
Improving information.
• Experience based design methodology.
• Information booklet designed by patients.
• Chosen as early CQUIN
target.
Quality in the round.
“The staff are marvellous, I cannot fault anyone of them, doctors, nurses, tea ladies and cleaners all special people.”
Infographics.
Key things we have learnt.
• The benefits of real time reporting at team level.
• Executive management team support is crucial.
• Ensure patients and families are part of your improvement team.
• Focusing on things that matter most has made sense.
• Investing in improvement has helped.
• Qualitative feedback appears particularly important .
• Transparency of reporting matters.