absolute necessity
TRANSCRIPT
“(…) WE WANT TO DISCUSS THE ABSOLUTE NECESSITY FOR THE
PROMOTION AND UNDERSTANDING OF HEALTHCARE DATA (…) IF WE
WANT TO TRANSFORM OUR HEALTHCARE SYSTEM, THE USE OF DATA AND
HOW THAT IS REPORTED MUST ALSO TRANSFORM
TO CHALLENGE AND CHANGE PERCEPTIONS.”NOCA ANNUAL
CONFERENCE 2020
“…IT IS WIDELY ACCEPTED THAT OUR SYSTEM IS FAR FROM
PERFECT AND IS NOT SERVING OUR CITIZENS AS IT SHOULD.”
DEPARTMENT OF HEALTH, 2019
Sláintecare Implementation Strategy
(…) THIS STRATEGY (SLÁINTECARE) SIGNALS THE GOVERNMENT’S
INTENTION TO BRING ABOUT A TRANSFORMATIONAL REFORM OF THE
HEALTH SERVICE. WE CAN’T DO THIS ALONE. WE LOOK FORWARD TO
WORKING WITH THE MANY STAKEHOLDERS TO DELIVER IT.” DEPARTMENT OF HEALTH, 2019
Sláintecare Implementation Strategy
“IN AN UNSTABLE COMPLEX SYSTEM, SMALL ISLANDS OF
COHERENCE HAVE THE POTENTIAL TO CHANGE THE WHOLE
SYSTEM.”
ILYA PRIGOGINE
Russian/Belgian physical chemist and The
Nobel Prize winner in Chemistry 1977
ILYA PRIGOGINE
Russian/Belgian physical chemist and The
Nobel Prize winner in Chemistry 1977
regain their pre-fracture level of functionLESS THAN 50% 01
HIP FRACTURE IMPLICATIONS
return directly homeLESS THAN 50%02
are admitted to long-term careOVER 20% 03
in-hospital mortality7-14%04
mortality within 1-year of surgery14-36%05
hip fractures represent two thirds of this cost
TOTAL IN-PATIENT COST FOR ALL FRACTURES IN THE OVER 65-YEAR AGE GROUP IS €58 MILLION
06
The Irish Hip Fracture
Database (IHFD) is a clinically
led, web-based audit that
measures the best practice
standards of care, known as
the Irish Hip Fracture
Standards (IHFS), and
outcomes of patients with hip
fractures.
IRISH HIP FRACTURE DATABASE
SIX STANDARDS PERFORMANCE
0
25
50
75
100
2017 2018 2019
15
7 4
73
81 80
6 12 11
68
90 97
83
98 97
68
97 98
Admission 4h Theatre <48h 0% Pressure ulcers
Orthogeriatrics Bone Health MDT
BEST PRACTICE TARIFF
€3000 for Q1 and Q2
2019
+€3000 Q3
"BEYOND THE COMPETITION BETWEEN HOSPITALS IN ACHIEVING ALL
STANDARDS SET BY THIS AUDIT AND OBTAINING THE FINANCIAL REWARDS
ASSOCIATED WITH BEST PRACTICE, WHAT MATTERS MOST FOR PUBLIC &
PATIENTS IS THE HEALTHCARE PROFESSIONAL’S EFFORTS, DETERMINATION &
COMMITMENT TOWARDS DELIVERING “THE RIGHT CARE, IN THE RIGHT PLACE,
AT THE RIGHT TIME BY THE RIGHT TEAM"BIBIANA SAVIN
Sage Advocacy
IHFD Public and Patient Interest (PPI) Representative
“the right care, in the right place,
at the right time by the right team"
ONLY 4% OF PATIENTS WERE ADMITTED TO COLLES WARD WITHIN 4H.
SOME PATIENTS WAITED MORE THAN 10 HRS!
Identify Leads and Champions for each
standard requiring improvement.
OUR PLAN IN 2018:
01STEP
STEP03
STEP04
Agree on measures
Implementation and
assessment
STEP02
Process mapping and value
stream analysis
STANDARD 1 ADMISSION IN <4H
Ambulance pre-alert
CodeHip Status override to Triage
(patient could be mis-triaged on
pain assessment)
New Integrated Care Pathway
Patient Fast track for Imaging
CodeHip Bleep
Unisex beds on Colles and
appropriate mattresses available
New Standard Operating
Procedure for Patient Admission in
the Ward
Fascia Iliaca Block Box
STANDARD 1 ADMISSION IN <4H
STANDARD 1:ADMISSION IN <4H
Data is now captured “live”
New KPI´s defined, also included
in the National Database
Business Intelligence support
with customised reports
New Educational programs
STANDARD 1 ADMISSION IN <4H
STANDARD 1 ADMISSION IN <4HFASCIA ILIACA BLOCK
0%
25%
50%
75%
100%
Oct-1
7N
ov-1
7D
ec-1
7
Jan-1
8
Feb-1
8
Ma
r-18
Apr-1
8
May-1
8
Jun-1
8
Jul-1
8
Aug-1
8
Sep-1
8
Oct-1
8
Nov-1
8
Dec-1
8
Jan-1
9
Feb-1
9
Mar-1
9
Apr-1
9
May-1
9
Jun-1
9
% Block done
WE HAVE THE HIGHEST INCIDENCE OF PRESSURE ULCERS IN THE
COUNTRY AMONGST PATIENTS WITH HIP FRACTURES
SJH Foundation small grants award
and BPT paid the device
New Standard Operating Procedure
for assessment of pressure areas
New KPI´s defined
New Educational programs
STANDARD 3:0% PRESSURE ULCERS
STANDARD 3: 0% PRESSURE ULCERS
Official results?
STANDARD 4 ORTHOGERIATRIC MEDICAL SUPPORT
STANDARD 5 BONE HEALTH
STANDARD 6 MDT ASSESSMENT
HARNESSING THE POWER OF DATA WAS KEY TO DEMONSTRATE THE
NEED FOR ACTION. CLINICAL AUDITS ARE INVALUABLE. NOCA,
PROMOTED AND SUPPORTED ITS USE CONTRIBUTING TO IMPROVED
QUALITY OF CARE FOR PATIENTS WITH HIP FRACTURES. OUR TEAMAT ST. JAMES’S WAS ALIGNED, FOCUSED AND EMPOWERED TO MAKE
CHANGES.
OUR PERCEPTIONS WERE CHALLENGED BY USING THE INFORMATION GENERATED
BY HIGH QUALITY DATA. CODEHIP IS AN EXAMPLE ON HOW HEALTHCARE CAN CHANGE WITH THE RIGHT SET OF TOOLS, PEOPLE AND SUPPORT (€?)
We now face another challenge:
Sustaining change
