reflections on hip fracture audit oh shit another boring audit talk
TRANSCRIPT
REFLECTIONS ON HIP FRACTURE AUDIT
A GREGORIHAIRMYRES HOSPITAL
EAST KILBRIDE
STIRLING 27.11.2002
REFLECTIONS ON HIP FRACTURE
AUDIT
Oh shit another
boring audit talk
HIP # AUDIT
• Assesses whole process of # Care– A&E process– Admission process– Surgical Assessment and processing– Anaesthetic care and processing– Surgery– Post op and Rehab– Complications
HIP # SAHFE DATABASE
1997 Start Audit Introduce change
1998 Measure change
1999 Fine tune changes
2000 and on Audit service
AUDIT
• Continuous process
• Recognition
• Reaction
• Change
• Reassess
The Aim - Improve Quality of Care
Morbitity
Mortality
In Patient Stay
Dependance
The workers
Cost
Inefficiency
Bed Occupancy
The Managers
HIP # AUDIT
• IS CONTINUING AUDIT JUST BORING NUMBER CRUNCHING PROCESS ?
BENEFITS
• Basis for increased funding of # service
COOKING PHILOSOPHY
INGREDIENTS
Patients Audit Nurse
Resources Interested Clinicians
Use the SAHFE Cookboook
OR
Adlib??????
REFLECTIONS ON THE RECIPESHIP # AUDIT
=FOLLOW-UP
Process of Audit Data collection led to patient contact and a Clinical Care Opportunity.
SOWhat else can be done with this?
RECIPE No 1
Audit nurse follow up of all hip#
Routine # clinic review replaced by Audit nurse contact at 4 and 12 months
>400 return patient appts p.a.
in # Clinic
Replaced by 30 pat
returns p.a.
ROUTINE OPA/RECALLS
0
50
100
150
200
250
300
350
400
1998 1999 2000 2001
RecallsOPA
RECIPE No 2
Audit nurse arranging for physioRx
Identification of need may be only for PhysioRx
Ability for direct referral by Audit nurse
RECIPE No 3
Audit nurse actions clinic review
Consultant review of all clinic returns agreed
Point of contact for patients and GPs circumventing clinic referral letters and needless waits
RECIPE No 4
Physiotherapy falls prevention and education
Contact used to get greatest benefit
Multidisciplinary use of Data
RECIPE No 5
Osteoporosis Education
Targeting Osteoporosis Interventions
RECIPE No 6
QUALITY ISSUES AND QUALITY ENHANCEMENT
Written Notes
DVT Prophylaxis
Anaesthetic charts
CLINICAL INCIDENT REPORTING
AUDIT
• Continuous process• gets easier to do with
system in place
• gets harder
to improve
the subject
This is f#~*inghard work
UNEXPECTED DISHES
• Telephone review became a clinical tool - “someone cared”
• Encouraged multi-disciplinary communication
• Saved money!
• Clinical governance tool– teaching aid
WHY HAS THE AUDIT BEEN SUCH A LOCAL SUCCESS?
• Local ownership
• Proactive clinician
• On site analysis
• Reaction to ALL data
• Multi-disciplinary participation
• Development and closed the loop
DESSERTS
AUDIT SHOULD BE SEEN AS A CLINICAL CARE TOOL
CLINICIANS MUST BE INVOLVED TO MAKE IT WORK
12 MONTH FOLLOW-UP ESSENTIAL
THANKYOU
?