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Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway-pilot study.

Abstract The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software. The initial four months analysis of this project showed significant improvement in patient flow within the hospitals. The overall length of stay was reduced by four days. Time in ED was reduced by 30 minutes, and the wait for rehabilitation reduced by three days. Overall time in rehabilitation reduced by 3-7 days depending on facility. On average, fast track patients spent 95 less hours in hospital, resulting in 631 bed days saved in this period, with projected savings of NZD700,000. No adverse effects were seen in mortality, readmission and functional improvement status. Fractured neck of femur has increasing clinical demand in a busy tertiary hospital. Length of stay, co-morbidities and waiting time for theatres are seen as major barriers to treatment for these conditions. Wait for rehabilitation can significantly lengthen hospital stay; also poor communication between the individual hospital management facets of this condition has been an ongoing issue. Lack of instant and available electronic information on this patient group has also been seen as a major barrier to improvement. This paper demonstrates how integration of service components that are involved in fractured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practice. This paper indicates that cooperation between health professionals and practitioners can significantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new zealand medical journal
Publication Year Start




PMID- 28494481
OWN - NLM
STAT- MEDLINE
DA  - 20170511
DCOM- 20170518
LR  - 20170518
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 130
IP  - 1455
DP  - 2017 May 12
TI  - Enhanced hip fracture management: use of statistical methods and dataset to
      evaluate a fractured neck of femur fast track pathway-pilot study.
PG  - 91-101
AB  - The increasing elderly population and subsequent rise in total hip fracture(s) in
      this group means more effective management strategies are necessary to improve
      efficiency. We have changed our patient care strategy from the emergency
      department (ED), acute orthopaedic wards, operating theatre, post-operation and
      rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All
      clinical data and actions were captured, integrated and displayed on a weekly
      basis using 'signalfromnoise' (SFN) software. The initial four months analysis of
      this project showed significant improvement in patient flow within the hospitals.
      The overall length of stay was reduced by four days. Time in ED was reduced by 30
      minutes, and the wait for rehabilitation reduced by three days. Overall time in
      rehabilitation reduced by 3-7 days depending on facility. On average, fast track 
      patients spent 95 less hours in hospital, resulting in 631 bed days saved in this
      period, with projected savings of NZD700,000. No adverse effects were seen in
      mortality, readmission and functional improvement status. Fractured neck of femur
      has increasing clinical demand in a busy tertiary hospital. Length of stay,
      co-morbidities and waiting time for theatres are seen as major barriers to
      treatment for these conditions. Wait for rehabilitation can significantly
      lengthen hospital stay; also poor communication between the individual hospital
      management facets of this condition has been an ongoing issue. Lack of instant
      and available electronic information on this patient group has also been seen as 
      a major barrier to improvement. This paper demonstrates how integration of
      service components that are involved in fractured neck of femur can be achieved. 
      It also shows how the use of electronic data capture and analysis can give a very
      quick and easily interpretable data trend that will enable change in practice.
      This paper indicates that cooperation between health professionals and
      practitioners can significantly improve the length of stay and the time in which 
      patients can be returned home. Full interdisciplinary involvement was the key to 
      this approach. The use of electronic data capture and analysis can be used in
      many other health pathways within the health system.
FAU - Gilchrist, Nigel
AU  - Gilchrist N
AD  - Orthopaedic Medicine, Canterbury District Health Board, Christchurch.
FAU - Dalzell, Kristian
AU  - Dalzell K
AD  - Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of
      Otago, Christchurch.
FAU - Pearson, Scott
AU  - Pearson S
AD  - Emergency Department, Canterbury District Health Board, Christchurch.
FAU - Hooper, Gary
AU  - Hooper G
AD  - Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of
      Otago, Christchurch.
FAU - Hoeben, Kit
AU  - Hoeben K
AD  - Planning and Funding Department, Canterbury District Health Board, Christchurch.
FAU - Hickling, Jeremy
AU  - Hickling J
AD  - Anaesthesia Department, Canterbury District Health Board, Christchurch.
FAU - McKie, John
AU  - McKie J
AD  - Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of
      Otago, Christchurch.
FAU - Yi, Ma
AU  - Yi M
AD  - Planning and Funding Department, Canterbury District Health Board, Christchurch.
FAU - Chamberlain, Sandra
AU  - Chamberlain S
AD  - Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury
      District Health Board, Christchurch.
FAU - McCullough, Caroline
AU  - McCullough C
AD  - Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury
      District Health Board, Christchurch.
FAU - Gutenstein, Marc
AU  - Gutenstein M
AD  - Emergency Department, Canterbury District Health Board, Christchurch.
LA  - eng
PT  - Journal Article
DEP - 20170512
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthroplasty, Replacement, Hip/*adverse effects
MH  - Emergency Service, Hospital/*organization & administration
MH  - Female
MH  - Hip Fractures/economics/*rehabilitation/surgery
MH  - Humans
MH  - Length of Stay/*statistics & numerical data
MH  - Male
MH  - Models, Statistical
MH  - New Zealand
MH  - Pilot Projects
MH  - Recovery of Function
MH  - Time-to-Treatment/*statistics & numerical data
COI - Nil.
EDAT- 2017/05/12 06:00
MHDA- 2017/05/19 06:00
CRDT- 2017/05/12 06:00
PST - epublish
SO  - N Z Med J. 2017 May 12;130(1455):91-101.

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