Good to Go: Partnering with Patients and Families for an Improved Experience Transitioning Home

Good to Go: Partnering with Patients & Families to Improve the

Experience of Going Home After Hip Fracture

1130-1230 on Thursday, February 25, 2016

B4 | HIP Hop Don't Drop: Three Stories Highlighting HIPstars

Disclosure Slide

• This project was funded by the

Canadian Foundation for Healthcare Improvement as part of the Canadian collaborative

“Partnering with Patients and Families for Quality Improvement”

Why this project? • Approximately 4,000 British Columbians

have a hip fracture each year.

• 22% will be back in hospital within 90 days

Patient experience can be improved… We can do better!

‘Well, one of the things that’s interested me, and I’ve been too stupid to ask…… I know the incision’s on the side of my leg. But nobody’s ever told me, you know, shown me a picture of my hip and said, this is where it got fractured, or this is where your leg is fractured.’

From : Heeding the Patients

Voice in Post-Hip Fracture Care

Transitions Sims-Gould, J.¹, Byrne, K.²,

MacDonald, V. ³, Carr, M.³, Hicks, E.¹, Khan, K.¹, & Stolee, P

“I was given a handful of pills- I said “which one of these is my heart medication? She (nurse) said ‘It doesn’t matter- you need to take them all anyway’ Ellen, 79

From our baseline qualitative data

@CFHI_FCASS cfhi-fcass.ca |

Project Aim Statement

What will improve: the patient experience of the transition home.

For whom: Hip fracture patients >age 65 years, returning to the community, after surgery for hip fracture

By when: September 2015

By how much: 10%


How did we measure patient experience?


What quantitative and qualitative data were gathered?

Stories, Surveys and Shadowing

2 Focus groups, 24 In depth interviews, 60 HCP surveys, ~ 90 patient surveys, field observation

How did we use this data to drive change? Regular staff meetings to review data, identify improvement opportunities and plan tests of

change.

PDSAs We tried What worked!! What didn’t!!

Fresh Start – reviewed daily by team & personalized for patient.

Giving Fresh Start to read with out ongoing personalized review.

Proactive bedside meetings with family/team.

Group classes – labour intensive and each person needed their own!!

Assigned staff person to support family with transition.

No one accountable for engaging patient/family for transition.

Focused home follow up phone call & visit using FS. Pilot Study at Surrey Newton

Pharmacist meeting in hospital and follow up phone call

Leaving them to flounder at home. Many don’t recall teaching.

Unanticipated problems arise with medications AFTER discharge.


One PDSA cycle: pharmacist visit in hospital, and a phone call after discharge

A certain subset of patients do not recall any discharge teaching (e.g. cognition, confusion, being overwhelmed)…

“Some things come up, only after discharge, such as: trouble sleeping, change of dose of a previous home medication, side effects of new medications;

These things may not necessarily be a concern in hospital, or patients may not be aware of them until they get home”

Pharmacist


What Process Measures did we track?


Delivery Of Education

Fr actur e Recovery for Seniors at Home:

A hip fr actur e r ecover y guide for pat ients & famil ies

http://www.hiphealth.ca/blog/FReSHStart

Toolkit for Recovery Your fracture/surgery Prevent risks e.g. delirium, UTI How/where to meet needs for home support & equipment Home safety/fall prevention Red flags & what to do Medication safety Follow ups: e.g. medical, bone health, exercise Exercises

http://www.hiphealth.ca/blog/FReSHStart


What assumptions did we make?

That data collection

would be straightforward……

BUT….

Staff training is required,…

staff turnover occurs

AND

Our target population are frail, and can be challenging to recruit


Key Results: What Happened to patient experience?

N= 58/150 patients ~ 40% response rate

20%


Staff turnover, staff training , (at one site , we had difficulties with the data collection – patient measures were incomplete)

Organizational re-structuring, changes in leadership for both organizations- a constant state of flux

Competing priorities / initiatives

Person dependent effect – scores dip when key staff are away– Champions and key staff assigned to this work are key for sustainability.

REQUIRES A SUSTAINED EFFORT TO SHIFT CULTURE:

CARE TRANSITION SUPPORT IS NOT A FRILL. IT IS VITAL!!

Challenges


What are we most proud of ?

Rapid communication across 2 Health Authorities, to learn from

each other’s mistakes and implement each other’s successes

Alignment with Accreditation Canada’s “Focus on transitions” report: ensuring evidence based

and rigorous

background knowledge and research to inform our priorities

Supports the Vision and Values of our Organization’s strategic plan,

to improve the patient and caregiver experience

Engaging the energy, commitment and enthusiasm of key clinical champions from both

health Authorities , across the transitions of care

( acute, rehab, community)

Partnering with the BC Ministry of Health Hip Fracture Redesign QI project for data collection and

dissemination of findings

Using the data, and the patient and caregivers voices to inspire our teams and drive improvements


What was our most significant lesson learned?

“Patient experience is more than lip service…It can drive improvements in care!

“If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it” Leonard Kish

Thoughts…

• Have you had success in sustaining similar projects?

• What strategies and tips did you use?


Thank you! Questions?

Dolores Langford Valerie MacDonald [email protected] [email protected]

mailto:[email protected]

mailto:[email protected]