Mr N Cooke
Mr T Friesem
Carol Bowler
YES
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NCEPOD An Age Old Problem (2010)
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NICE Hip Fracture Guidelines CG124
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National Hip Fracture database ; additional
income if we meet the best practice tariff
criteria
Mortality and morbidity figures reflects quality
of service
It is cost effective to deliver timely,
appropriate, high quality care
Effective and efficient utilisation of theatre
resources
Reduced length of stay
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Better utilisation of theatre resource
To achieve best practice tariff when caring for
elderly patients with neck of femur fracture
Improve patient experience and outcomes
Empower team
Sustain change
Identify future service developments
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Team approach
Identify waste and defects
Reduce waste and defects
Measure effect of changes
Review result of change
We used the LEAN methodology to help us
achieve our goal. A variety of defects and
waste were identified....
Current
 Paper booking forms
are not completed for
all theatre patients in a
timely manner
 Forms are often
inaccurate and delays
arise
 If booking forms are
delayed then the theatre
list is not produced and
first case is delayed
Planned change
 Night shift theatre staff
check forms currently
 Plan to pilot 2 electronic
theatre booking systems
once the theatre IT
system has been
upgraded.
Before
 Patient case notes not
well organised
 Anaesthetist spent
valuable time looking
for notes and relevant
blood results ECG etc
After
 Notes placed on
designed shelf in both
ward areas
 Results printed out and
checklist introduced to
ensure all test results
were available and filed
in casenotes
 Now all patient notes
will be found at patients
bedside in wall
mounted holders
(further progress)
Before
 Theatre staff send for
patient
 Ward staff not always
available at 8-9am as
ward busy and delays
begin
 Ward staff do not
prepared 1st patient
until they have a
theatre list
After
 Ward staff prepare 1st
patient for 8.30am
 Theatre staff x 2
collect patient at
8.45am whenever
possible
Before
 First patient was held
in waiting bay which
delayed anaesthetic
After
 Patient went straight
from ward into
anaesthetic room
Before
 Patient often waits in
theatre for arrival of
anaesthetist and
surgeon
After
 Surgeon and
anaesthetist arrive for
brief at 9am
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Better utilisation of theatre time
Hip fracture patients treated in a timely
manner therefore BPT payment may apply if
remaining criteria achieved
Reduced length of stay, reduced mortality and
morbidity.
Better patient experience and improved
outcomes
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Electronic theatre booking ; 2 systems to pilot
planned for January and March
Access lounge will free up valuable time on
ward during busy morning activities therefore
1st theatre case should always be prepared for
prompt start.
Adoption of the NICE guidelines 124 for hip
fracture patients
Team continues to strive to achieve excellence
for all patients attending NTHFT.
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The course enabled the team to focus on how
our roles, skills and mindsets can influence
clinical practice and improve the patients
experience and outcomes.
The Belbin self assessment and 360 degree
feedback increased our self awareness and
enabled us to identify areas where
improvements can be made to our leadership
skills.
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Patients and carers come first, last and always
(K Jarrold).
Florence Nightingale recognised the
importance of light, space, ventilation and
single room accommodation to improve the
health of her patients ( reading from A Foster).