the basildon experience - nhfd · 2014. 5. 22. · ot pt ot nof facilitator nurses . tier 3 ccg...
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What happens in Bas Vegas stays in Bas Vegas…..Maintaining Low Mortality: The Basildon Experience NHFD March 12th 2014
Dr Luke Hounsom
Consultant Orthogeriatrician
Basildon University Hospital
• Medium-sized 667 bedded Major Acute DGH with on site cardiothoracics.
• One of the first 10 Foundation Trusts
• Subserving approx 400,000
• 7% non-white ethnic minorities
• 93.3% bed occupancy (2012)
• SHMI 113 for non-elective
• HSMR 105
Breaking new ground in hip fractures •1980’s
• Dr Gill Jenner appointed as an
Orthogeriatrician
• Developed a rehabilitation ward
LIONEL COSIN
Breaking new ground in hip fractures •2002
• Centralisation of wards
• Allowed for some preoperative assessment and the development of
‘hip fracture nurses’
Breaking new ground in hip fractures •2006
• NHS Institute secondment
• Set out the importance of perioperative care in the context of a Multidisciplinary team
Breaking new ground in hip fractures
•2007
• Dr Shilpa Raje appointed as a Perioperative Orthogeriatrician
• Developed services on the Trauma wards
LINFORD BULPHAN
Basic Patient Journey
A&E
Trauma Wards
Theatre
Rehabilitation
Home
Mortuary
Care
Basic Team Structure
Joint Admission Protocol
Linford Bulphan
Orthopaedic FY1 x2 FY2 x1
Orthopaedic FY1 x2 FY2 x1
Orthogeriatric Consultant (NOF)
Consultant (non-NOF) Geriatric Medicine StR
PT OT
PT OT
NOF Facilitator Nurses
Tier 3 CCG Fracture neck of femur (Hospital admitted patients)
Q1 – Q4 2012/13 Dr Foster
Peer Episodes Spells Superspells SAR SAR low SAR High
SWE PCT 824 593 483 117.44 108.14 127.33
B&D PCT 415 182 177 103.31 88.81 119.51
Mortality 2013-2014
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
Jan
-13
Feb
-13
Mar
-13
Ap
r-13
May
-13
Jun
-13
Jul-
13
Au
g-13
Sep
-13
Oct
-13
No
v-13
Dec
-13
Jan
-14
Feb
-14
in-hospital mortality
30 day mortality
Rate of Spinal Anaesthetics
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
In-hospital fractures and pressure sores (2013-2014)
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
Hip Fracture Demographics 2013-2014 Walking Aids Number Percentage
Without aids 156 43.2
One aid 87 24.1
2 aids or frame 111 30.7
Wheelchair or bedbound
7 1.9
Admitted from
Own home/supported living 280 77.6
RH 56 15.5
NH 7 1.9
In Hospital 6 4.4
Hip Fracture by ASA
ASA Number Percentage
1 6 1.7
2 79 21.9
3 192 53.2
4 69 19.1
5 3 0.8
UNK 12 3.3
Hip Fracture Demographics 2013-2014
Age Range Number Percentage
>60 < 70 21 5.8
70-80 81 22.4
80-90 176 48.8
> 90 83 23.0
Type of Fracture
Intracapsular 226 66.6
Intertrochanteric 105 29.1
Sub-trochanteric 30 8.3
Hip Fracture Metrics
Metric
Time to ward 9.8 hours
Time to Theatre 35.1 hours (31.1 National)
Length of Stay 16.2 days (19.0 National)
Pre-op Assessment
318 (88.1%) (71.2 National)
Bone Protection 357 (98.9%)
Falls Assessment 358 (99.2%)
What we do well
• VTE Prophylaxis (just over 98%)
• Continuity of care (weekly Trauma Consultant, NOF Facilitator Nurse Specialists)
• Patient flow (NOF proforma and dedicated receiving trauma wards)
• Pressure Sores (2.8%: 2013-2014)
• C.Diff (14 Q1 2013) MRSA bacteraemia rates (2 in the last year)
• Nutrition (dedicated Nutrition pathway)
• Dedicated Trauma Theatre sessions
• Weekly MDT (dedicated OT PT Dietician)
The future
• Managing in-hospital(NHS) injurious falls (4.3: 2013-2014)
• 7 day services
• Reoperation rates
• Is the maintained low mortality related to relative lower frailty?
Thanks Any Questions?
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