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Fast-NOF: Innovating Fractured Neck of Femur Patient Treatment at HRT1215

This poster session at the HRT1215 Innovation Awards in Sydney on October 11th and 12th, 2012, showcases the Fast-NOF initiative led by Peter Mason from QE2 Hospital. The innovation aims to decrease the average length of stay for fractured neck of femur patients in acute care. By implementing multi-disciplinary teams, champion clinicians, best practice pathways, and continuous feedback, the project achieved significant improvements in patient care and outcomes. Lessons learned emphasize staff involvement, process mapping, and regular performance reviews for sustained enhancements in patient care.

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Fast-NOF: Innovating Fractured Neck of Femur Patient Treatment at HRT1215

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  1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 FAST-NOF Fast, Appropriate, Safe Treatment for Fractured Neck of Femur PatientsPresenter: Peter Mason Hospital QE2 3-3a_HRT1212-Session_MASON_QE_SA

  2. KEY PROBLEM Prior to commencing changes Performance in DRG IO8 - # NOF emergency patients:

  3. AIM OF THIS INNOVATION To decrease the ALOS for a patient with a # NOF in the acute care environment

  4. BASELINE DATA • What did this tell us? • Our ALOS was high & not getting better • Out of 12 similar sites in HRT, we ranked 10th in RSI performance • There were many barriers to prevent us achieving best practice • #NOF procedures were deemed ‘low priority’ when compared to other surgical procedures

  5. KEY CHANGES IMPLEMENTED Developed a multi-D team from across the patient journey Identified senior clinicians to be ‘Champions’ Reviewed literature to define best practice Communicated with HRT exemplar units Identified Takt time of work demand Used Process Mapping to identify barriers Developed standardised pathways that were developed & agreed upon by clinicians Measured critical components of the pathway

  6. KEY CHANGES IMPLEMENTED Sought feedback from patients Focussed on improving teamwork between the departments Brought forward key activities to minimise delays Met regularly (2 years later, we still meet & the team is even bigger!) Fed back performance on a regular basis Celebrated our wins We made management of patients with a #NOF a core business of the hospital (MAKE NOFs SEXY!)

  7. OUTCOMES SO FAR • In the first 6 months of the project; • ALOS ↓ 4.3 days, • Time from ED to theatre ↓ to below best practice guidelines (24 hours) • HRT data benchmarking; • Av. Emerg. Surgery Lag • 2008-9 =1.6 days • 2010-11=1.1 days • Complication rate • 2008-9 = 36% • 2010-11 = 18% • (HRT exemplars = 28%) • Improvements have essentially been sustained • 2 years later, we still meet monthly to address barriers • Current goal is to create a seamless transition between acute & rehab

  8. LESSONS LEARNT ‘Tell me, I’ll forget, show me, I may remember, but involve me and I’ll understand’ (Chinese Proverb) Bring staff from across the patient journey together to address barriers to best practice Follow an improvement methodology Process mapping helps staff understand causation of problems Understanding causation helps staff prioritise solutions Meet & feedback performance regularly There is no end point to improving the care of patients with a #NOF

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