1. Steve Fordham December 2016
Steve Fordham
December 2016
@EMExeter

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6. Describe the patient?
What is the problem?
What evidence is available to show that this is actually a problem?
@EMExeter

7. 104 Patients identified using the discharge code “Hip Dislocation”
102 Adult Patients confirmed Dislocated Hip Prosthesis
7 due to ED pressures
7 medically unfit
5 Failed reduction
1 patient refused
Reduction of Dislocated Hip Prosthesis achieved in ED?
No (20 Patients)
Yes (82 Patients)
9 Discharged from ED
73 admitted
56 Discharged next day

8. What are we trying to accomplish (Aim)?
Stakeholders (consider the project from other perspectives)
Methodologies
PDSA: Plan/Do/Study/Act
@EMExeter

9. Resus for Procedural Sedation
Sleigh Crash
0645hrs 1
Ambulance
0729hrs 2 4 6 5 9 10 7 3
X-ray
1015hrs
Resus for Procedural Sedation
0931hrs
0848hrs
Majors
0824hrs
Triage in RAT room
0820hrs
ED attendance
0814hrs
1027hrs
Hospital stay
overnight
Transfer to ward
1211hrs
Ortho
referral
1040hrs 12 13
Request for OT aids at home
1225hrs
OT assessment
1150hrs
Physio
assessment
1037hrs 16 15 14 17
OPD follow-up: booked for 2/52
Transport home
1530hrs 11 8

11. How will we know that change is an improvement (Measure)
What change can we make that will result in an improvement (Change)
@EMExeter

12. Secondary Drivers The Goals Action Balancing measures
Reduce admissions of patients following relocation of their Hip Prosthesis in ED
Maintain patient care and safety
Improve Patient Experience
Improve Discharge Processes
Improve Cost effectiveness
Direct discharge from ED to patient’s own home
Use of Procedural Sedation in ED if clinically appropriate
Out-patient follow-up with original Orthopaedic consultant
Improve flow in elective Orthopaedic admissions
Reduce emergency admissions
Increase availability of ward-based OT and physio
To create a “Hip Dislocation Pathway” algorithm
Primary Drivers
Secondary Drivers
The Goals
Action
That neither the medical need of the patient or the time spent in ED should be compromised by the use of the Hip Dislocation Pathway
Balancing measures

13. How will we know that change is an improvement (Measure)
Patient centred/how will this improve patient care - it is ok to use a surrogate marker of this.
What change can we make that will result in an improvement (Change)
Choose the big wins from the process map
Short pdsa cycles are better
@EMExeter

15. Variation is natural and inevitable - aim of QI is to reduce variation over time
The dimensions of Quality:
Safe
Effective
Patient centred
Timely
Efficient
Equitable
QA vs QI - Assurance is measuring compliance with standards, Improvement is continually improving processes to meet standards
@EMExeter

16. What is a quality QIP
Made a difference to patients
Started from a problem not a solution
Used a recognised QI methodology
Good narrative
Good team work
Based on good evidence
Good planning
Continuous measurement
Iterative process
Reflective
@EMExeter

17. No planning What is NOT a good quality QIP
Implementing a solution and not fitting it to a problem
Solo player
No evidence of engagement
No evidence of reflection
Based on making things cheaper
A audit polished up or implementing a pro forma
Just using a lot of tools with little understanding of the methodologies
No planning
@EMExeter

18. Happy Christmas
@EMExeter