planning patient care and achieving best practice tariff · best practice tariff • 1. time to...
TRANSCRIPT
![Page 1: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/1.jpg)
Planning patient care and achieving Best Practice Tariff
Dr John Tsang MB ChB, FRCP
Consultant Orthogeriatrician
Lead clinician Orthogeriatrics Service
National Hip Fracture Database – North West Regional Meeting
13th March 2013
![Page 2: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/2.jpg)
![Page 3: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/3.jpg)
• If you or a loved one suffered a hip fracture, would you recommend your hospital?
![Page 4: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/4.jpg)
• Why hip fractures are so important
• Planning patient care
• Achieving BPT
• Top ten tips
![Page 5: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/5.jpg)
Why hip fractures are so important
• ‘rather be dead than
admitted to a nursing home after a hip fracture’ 80% women over 75 yrs BMJ Feb 2000
2000,000,000
![Page 6: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/6.jpg)
Planning patient care
![Page 7: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/7.jpg)
2008
![Page 8: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/8.jpg)
2009
• LEAN services
• Process mapping
![Page 9: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/9.jpg)
2010-12
Specialty Limb Reconstruction
Mr. B. Narayan
Mr. N. Giotakis
Shoulder & Elbow
Mr. M. Kent Mr. M. Smith
Hand & Wrist Mr. D. Brown Mr. G. Cheung
Pelvis & Acetabulum
Mr. S. Kalra Mr. G. Kumar
Hip & Knee Miss J. Banks Mr. B. Kapoor
Foot & Ankle Mr. A. Roach Mr. C. Walker
OG Dr J Tsang Dr H Cronin
Trauma Co-ordinators
Mrs H Haines Mrs M Nolan
Hip fracture practitioner
Mr M Thompson
![Page 10: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/10.jpg)
Current services
• All hip fractures admitted under joint care
• Enhanced recovery pathway
• Daily consultant orthogeriatrician and orthopaedic surgeon WR’s
• Daily consultant-led MDT -all hip fractures discussed
• Monthly multiprofessional hip fracture meeting
• Monthly trauma directorate meeting
![Page 11: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/11.jpg)
Achieving BPT
![Page 12: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/12.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 13: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/13.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 14: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/14.jpg)
40
50
60
70
80
90
100
RLUH
National
BPT Surgery within 36 hrs
![Page 15: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/15.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 16: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/16.jpg)
BPT Joint care
0
10
20
30
40
50
60
70
80
90
100
2011 2012
RLU
![Page 17: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/17.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 18: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/18.jpg)
HIP FRACTURE MANDATORY REQUIREMENTS BY ADMITTING SHO or SPR
• 1. All patients must be clerked on the hip fracture pathway only (not A & E or continuation sheets)**
• 2. All patients must have pre-operative 10 point Abbreviated Mental Test Score (AMTS) **
• 3. All patients should be prescribed IV paracetemol & Oramorph PRN as per analgesic algorithm unless contra-indicated
• 4. All patients admitted on Warfarin, give stat dose of IV Vitamin K 2mg and follow trust clinical guideline
• 5. All tests that may delay surgery must be done urgently
• 6. All patients should have VTE assessment and prescribe prophylactic Fragmin unless contra-indicated
• **including subtrochanteric fractures • **including in-hospital hip fractures
![Page 19: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/19.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 20: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/20.jpg)
BPT Perioperative medical assessments
0
10
20
30
40
50
60
70
80
90
100
Apr - Oct
11
Nov - Apr
12
May - Jun
12
Jul - Oct
12
Nov - Jan
13
RLUH
![Page 21: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/21.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 22: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/22.jpg)
BPT Geriatrician-led MDT
![Page 23: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/23.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 24: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/24.jpg)
Blue Book (std 5) Bone health assessment and treatment at discharge
![Page 25: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/25.jpg)
50
55
60
65
70
75
80
85
90
95
100
2010 2011 2012
RLUH
National
Blue Book (std 6) Specialist falls assessment
![Page 26: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/26.jpg)
Best Practice Tariff
• 1. Time to surgery within 36 hrs
• 2. Admitted under joint care Consultant Geriatrician and Consultant Orthopaedic Surgeon
• 3. Admitted using assessment protocol agreed by Geriatric Medicine, Orthopaedics and Anaesthetics
• 4. Assessed by Geriatrician peri-operatively
• 5. Post-operative Geriatrician-led MDT rehab
• 6. Falls and bone health assessment
• 7. Two AMTS pre and post op
![Page 27: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/27.jpg)
AMTS
0
10
20
30
40
50
60
70
80
90
100
Apr-Jun 12 Jul-Sep 12 Oct-Dec 12
Pre-op
Post-op
![Page 28: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/28.jpg)
It’s not all about the tariff
• Dementia care in orthopaedics
• Comprehensive cognitive screening
• Delirium management
• Nutritional support
• Fascia iliaca nerve blocks
• Hip fracture programme – ESD
• Pre-op risk assessment
• Catheter pathway
• Continence assessment
• Bowel care pathway
• Specialist pharmacy education and medication review
• Information provision to primary care
![Page 29: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/29.jpg)
Dementia care in orthopaedics
![Page 30: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/30.jpg)
Hip Fracture Pathway
• Improvement in all areas
0
20
40
60
80
100
Information Malnutrition
Pre
Post
![Page 31: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/31.jpg)
Nutrition in hip fractures
1441.4 1918.2
47.3 71.5
![Page 32: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/32.jpg)
Early removal urinary catheters -HOUDINI B
0
20
40
60
80
100
Pre
Post
![Page 33: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/33.jpg)
Top ten tips 1. LEAN services
2. Dedicated area for all hip fractures
3. Hip fractures 1st on the list
4. Proactive work eg AMTS, mandatory requirements
5. Monthly multidisciplinary hip fracture meetings
6. Information provision –monthly performance review
7. Non-clinical leadership -induction to trust board
8. Clinical leadership – pre-operative to discharge
9. Supportive team/adequate resources –audit department, specialist nurses, junior doctors, consultant colleagues
10.Not all about the tariff! –develop other care aspects
![Page 34: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/34.jpg)
Summary
• Collaborative work achieves high levels of best practice
![Page 35: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/35.jpg)
• If you or a loved one suffered a hip fracture, would you recommend the Royal?
Yes!
![Page 36: Planning patient care and achieving Best Practice Tariff · Best Practice Tariff • 1. Time to surgery within 36 hrs • 2. Admitted under joint care Consultant Geriatrician and](https://reader036.vdocument.in/reader036/viewer/2022062605/5fceb811e273d7361d418884/html5/thumbnails/36.jpg)
Questions?