12th May 2017, Volume 130 Number 1455

Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein

In New Zealand, approximately 3,500 people over the age of 50 were hospitalised with a hip fracture in 2013 with the majority being related to falls.1 The rate of hip…

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Summary

This paper demonstrates how integration of service components that are involved in frac-tured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practise. Cooperation between health professionals and practitioners can signifi-cantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

Abstract

The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using ‘signalfromnoise’ (SFN) software. The initial four months analysis of this project showed significant improvement in patient flow within the hospitals. The overall length of stay was reduced by four days. Time in ED was reduced by 30 minutes, and the wait for rehabilitation reduced by three days. Overall time in rehabilitation reduced by 3–7 days depending on facility. On average, fast track patients spent 95 less hours in hospital, resulting in 631 bed days saved in this period, with projected savings of NZD700,000. No adverse effects were seen in mortality, readmission and functional improvement status. Fractured neck of femur has increasing clinical demand in a busy tertiary hospital. Length of stay, co-morbidities and waiting time for theatres are seen as major barriers to treatment for these conditions. Wait for rehabilitation can significantly lengthen hospital stay; also poor communication between the individual hospital management facets of this condition has been an ongoing issue. Lack of instant and available electronic information on this patient group has also been seen as a major barrier to improvement. This paper demonstrates how integration of service components that are involved in fractured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practice. This paper indicates that cooperation between health professionals and practitioners can significantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

Author Information

Nigel Gilchrist, Orthopaedic Medicine, Canterbury District Health Board, Christchurch; Kristian Dalzell, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch; Scott Pearson, Emergency Department, Canterbury District Health Board, Christchurch; Gary Hooper, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch; Kit Hoeben, Planning and Funding Department, Canterbury District Health Board, Christchurch; Jeremy Hickling, Anaesthesia Department, Canterbury District Health Board, Christchurch; John McKie, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch; Ma Yi, Planning and Funding Department, Canterbury District Health Board, Christchurch; Sandra Chamberlain, Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, Christchurch; Caroline McCullough, Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, Christchurch; Marc Gutenstein, Emergency Department, Canterbury District Health Board, Christchurch.

Correspondence

Dr Nigel Leslie Gilchrist, Orthopaedic Medicine, Canterbury District Health Board, The Princess Margaret Hospital, PO Box 731, Christchurch.

Correspondence Email

nigel.gilchrist@cdhb.health.nz

Competing Interests

Nil.

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