1. Mr N Cooke Mr T Friesem Carol Bowler

2. YES

3.  NCEPOD An Age Old Problem (2010)  NICE Hip Fracture Guidelines CG124

4.  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

5.  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

6.  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....

7. 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.

8. 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  Patient case notes not well organised  Anaesthetist spent valuable time looking for notes and relevant blood results ECG etc

9. 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 1 st patient until they have a theatre list After  Ward staff prepare 1 st patient for 8.30am  Theatre staff x 2 collect patient at 8.45am whenever possible

10. Before  First patient was held in waiting bay which delayed anaesthetic After  Patient went straight from ward into anaesthetic room

11. Before  Patient often waits in theatre for arrival of anaesthetist and surgeon After  Surgeon and anaesthetist arrive for brief at 9am

13.  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

14.  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 1 st 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.

15.  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.

16.  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).