Hip Fracture Unit Clinical presentation to Trust board Dr I - PowerPoint PPT Presentation

Hip Fracture Unit Clinical presentation to Trust board Dr I Wilkinson, Dr T Giokarini-Royal 22 December 2016 An Associated University Hospital of Brighton and Sussex Medical School

Introduction 500 patients per year • December 2015 to Local SHA National November 2016 Avg time to orthopaedic 8.8 12.1 9.9 ward (hrs) Avg time to theatres (hrs) 25.1 29.0 31.7 Avg Trust length of stay 19.2 19.8 20.1 (days) Admitted from December Local% SHA% National% 2015 to November 2016 Own home/sheltered 79.6 81.1 80.9 housing Residential care 12.0 9.7 11.1 Nursing care 7.3 9.1 7.8

Age of patient 50 45 40 35 30 ESH 25 Local 20 National 15 10 5 0 60-70 70-80 80-90 >90

Best practice tariff Surgery in <36 hours Ortho- MDT geriatric assessment review in 72hrs BPT Falls and Admitted on bone health joint care assessment protocol Pre and post op AMTS

A nutritional assessment during the Persistence admission with bone Falls and bone Joint treatment health Protocol assessment after discharge A delirium assessment Proposed Pre op AMTS BPT during the MDT admission assesment Assessed by physiotherapist Orthogeriatric the day review in 72hrs following surgery Surgery in <36 Post op hours AMTS

Best practice – ESU. East Surrey Hospital

Involvement in regional work Regional QI program for hip fracture care • Additional metrics • - Pain management - Delirium assesment - Peri-operative risk assessment and management - Therapy assessment

November 2015 – September 2016 100% 20% 40% 60% 80% 0% Dynamic Pain Score IV Paracetamol Pre-operative Nerve Block Post-Operative Pain Measured Pre-Operative NHFS 4AT @ 24-36 hrs Post-Operative 4AT @ 4-7 days Post-Operative Patient Able to Stand Day One Initial Physiotherapy Goals Set ESU Rate CQS KSS Rate ACS Data Completeness

Day 4 delirium assessment Pre-op nerve block insertion Post operative pain assessment 100% 100% 100% 80% 80% 80% 60% 60% 60% 40% 40% 40% 20% 20% 20% 0% 0% 0% Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 East Surrey Hospital KSS East Surrey Hospital KSS East Surrey Hospital KSS

Peer support visit Sharing of best practice

Key learning points Document discussion from trauma meeting • Review ward environment – esp. MDT space, • rehab space on ward, quiet room and staff room Expand / adapt FICB service to ED team • Develop services to ensure parity for patients with • other fragility fractures