Orthogeriatrics: Acute Hip Fracture Management Project

Transcription

1 Orthogeriatrics: Acute Hip Fracture Management Project Peak Union Forum Friday, 29 January 2015 Dr John Maddison

2 Orthogeriatrics: Acute Hip Fracture Management Project The purpose of this project was to develop a statewide clinical pathway and model of care that provides equitable quality patient care in the most cost effective manner. Aligned to meet the national standards: Australian Commission of Safety and Quality in Health Care s Hip Fracture Care: Clinical Care Standards; and Australian & New Zealand Hip Fracture Registry s Australian and New Zealand Guideline for Hip Fracture Care; Improving Outcomes in Hip Fracture Management of Adults, September 2014 Align to Transforming Health standards and provide: Clinician led Patient centred Evidence based best practice care

3 Process to date Orthogeriatrics: Acute Hip Fracture Management Workshop was held in June 2016 with over 80 attendees across clinical disciplines and Local Health Networks. Expert Work Group was chaired by Dr John Maddison and Dr Mark Inglis. Expert Work Group was developed to fine tune the specific information and to complete the project requirements. The Expert Work Group had representation from multi-disciplinary clinicians disciplines, workforce and consumer advocates. There was representation from all Local Health Networks with the exclusion of WCHN as they do not provide care within the patient demographic.

4 Expert Work Group Membership Domain Member Member s Position Allied Health Megan Satanek Manager, Dietetics & Nutrition, SALHN Allied Health Nerida Smith Clinical Senior Occupational Therapist, NALHN Allied Health Melissa Teo Specialist Pharmacist, NALHN Allied Health Adam Govier Director, Exercise Physiology & Physiotherapy, CALHN Consumer Judy Smith Consumer Advocate Consumer Lyn Whiteway Consumer Advocate Country Health SA Peter Chapman Chief Medical Advisor, CHSA LHN Medical Tim Semple Consultant Anaesthetist, CALHN Medical Tariq Nehvi Emergency Staff Specialist, NALHN Medical Pazhvoor Shibu Senior Geriatrics Consultant, CALHN Medical Mellick Chehade Orthopaedic Trauma Consultant, CALHN Nursing Cheryl Kimber Orthopaedic Nurse Practitioner, SALHN Nursing Kristian Sanchez Clinical Services Coordinator, CALHN Nursing Anita Taylor Orthopaedic Nurse Practitioner, CALHN SAAS Richard Larsen Operations Manager, Patient Safety & Quality Workforce Charmaine Hosking Workforce Strategist, SA Health

5 Orthogeriatrics: Acute Hip Fracture Management Clinical Pathway

6 Notable Service Improvements in the new Model of Care (1 of 3) SAAS Response Peri-urban patients, within 60 minutes via road from a Hip Fracture Centre will be taken directly to the Hip Fracture Centre Standardised analgesia provided Presentation and Diagnosis Analgesia to be reviewed and/ provided when necessary on presentation Standardised emergency department assessment across all emergency departments Standardised pre-operative medical investigations Ensuring patient receives pain management for maximum comfort prior to medical investigations. Patient admitted to ward Defining orthopaedic ward and an orthopaedic bed card with both the orthogeriatric & orthopaedic consultant name listed Non-Hip Fracture Centre to have allocated Hip Fracture Centres to streamline transfers.

7 Notable Service Improvements in the new Model of Care(2 of 3) Pre-operative ward care Defining pre-operative ward care, including default diet Defining pre-operative medical assessment requirements for both orthogeriatrics and orthopaedics Introduction of morning multi-disciplinary team meetings between all specialities for case management and theatre scheduling Defining theatre hours of operation to facilitate KPI of patients in theatre the same day or next day in the AM (36 hours) Intra-operative care Defining intra-operative requirements for anaesthesia and orthopaedics Requiring only SA Health contracted prostheses and consumables to be used in surgery unless there is a direct clinical need for a non contracted item Defining recovery unit stay, including requirements for a patient to be considered stable to be discharged back to the ward.

8 Notable Service Improvements in the new Model of Care (3 of 3) Post-operative care Defining the level of post-operative ward care for day of surgery as well as ongoing post-operative ward care Setting mobility and function guidelines Defining patient achievements to determined if medically stabled for a supported discharge Supported discharge Defining discharge locations and acknowledging the difference between discharge locations Stipulating the specific requirements to be provided to the patients at discharge Mandate that all patient information to be entered into Hip Fracture Registry, to interface with SA Health as a data tool.

9 Key Performance Indicators The EWG has supported the development of a data dashboard that will be released for testing by the LHN s early in The KPI s recorded within the Hip Fracture Dashboard are: Patients Average length of stay Average length of time in emergency department Percentage of patients to theatre within 48 hours of admission Mortality, inpatients Mortality, 30 days post discharge Percentage of patients seen by physiotherapist day one post surgery Further KPI s being investigated to be included within the Hip Fracture Dashboard are: Length of time between a patient being discharge ready and actual discharge

10 Implementation Challenges (1 of 2) Development of 7 day orthopaedic service at LMH Capacity of ED s at all Hip Fracture Centres Appropriate upskilled of CHSA emergency department staff Capacity to operate 7 day a week orthopaedic theatre at FMC & TQEH Capacity to operate 7 day a week consultant led orthogeriatric service at all Hip Fracture Centres 24/7 timely access to medical imaging and pathology Access to 7 day a week allied health services

11 Implementation Challenges (2 of 2) Ability of SAAS and RFDS to facilitate timely up transfers to ensure patients are in theatre in a timely manner Ability of SAAS and RFDS to facilitate down transfers in a time appropriate Access to inpatient sub-acute rehabilitation services CALHN site allocation Adequate administrative support Appropriate level of resourcing of Aboriginal Liaison Officers to be included within the patients shared care model

12 What s Next? The draft Model of Care and is in the process of being prepared in readiness for consultation and the project Service Design Review is being completed. SA Health will launch the Model of Care for consultation for a four week period, anticipated no later than April Consultation will include industrial bodies Consultation will be reviewed and project will be completed and presented to: Ministerial Clinical Advisory Group (MCAG); Transforming Health Operational Management Committee (THOMC); and Transforming Health Implementation Committee (THIC) for endorsement Anticipated that implementation to commence on 1 July 2016