1. The Health Roundtable 3-3a_HRT1215-Session_NEILSON_AUSTIN_VIC Care of the Patient with a Fractured Neck of Femur Presenter: Fiona Nielsen Hospital Austin Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1

2. The Health Roundtable KEY PROBLEM Polaris had a longer length of stay (36%) for DRG 108 than exemplar health services. We could save a potential 700 bed days by matching exemplar health services. But We all went to look at the care we were delivering to this particularly vulnerable group of patients. The clinicians and the executive, walked through the steps of patient’s journey to see for themselves. When we met together afterwards we all knew – we could do better than this: Variable care delivery Inadequate and unmonitored pain relief Delays to theatre Prolonged and unmonitored fasting Peri operative complications - delirium 2

3. The Health Roundtable AIM OF THIS INNOVATION Provide quality care to this patient group, focus on what really matters. Reduce variation in care delivery – ‘every patient, every time’. Reduce variation in our systems –Patients to theatre within 48 hours Manage fasting times- No patient to fast longer than 12 hours All patients to have their pain managed and monitored All patients assessed and monitored for delirium 3

4. The Health Roundtable BASELINE DATA- Long length of stay Long delays to theatre and unclear plans led to prolonged fasting 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED Hunger Clock. Counts down patient fasting time. 12 hour tolerance – if the patient does not have a firm plan then the fast is broken Early detection and treatment of delirium Perioperative Pain Plan. All patients receive full pain management. Patients to theatre within 48 hours 5

6. The Health Roundtable OUTCOMES SO FAR OutcomesJuly to December 2008July to December 20112011- 2012 Bed Saving DaysPotential 700Actual 520Actual 330 Average Length of Stay 13.2 Days 36% Longer than 4 Exemplar 8.3 Days 13% Shorter than all HRT 9.3 Days 3% Shorter than all HRT average In the dominant age group at Polaris-(80+) ALOS 9.7 days – 7% shorter than all HRT ALOS at 10.5 days Mode Length of Stay9-11 days3-5 Days % Discharged Home ( not to other campuses or facilities 23%30% % Emergency Readmission Rate 5.8%1.9%2.9% (34% lower than HRT average) Relative Stay index107%60%72% Average Age79 Years76 Years77 Years And Ongoing Most patients to theatre in 24 hrs, all within 48 hrs 6

7. The Health Roundtable LESSONS LEARNT Stay the course, don’t listen to No Consider the use of Failure Effects Analysis Mode, before final roll out of any intervention Clinical and executive leadership and support are essential, but support the project lead and staff too. Configure your Steering Committee and then have them delegate representatives for you to work with Excellence will do, perfection will burn you out Hospitals are Frogs- not Bicycles. - Alistair Mant Also 7