Streamlining an existing hip fracture patient pathway in an acute tertiary adult Irish hospital to improve patient experience and outcomes
| Autor: | Seán Paul Teeling, Eithne Mullen, Caitriona Murphy, Karrie Hogan, Ronan O'toole |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Psychological intervention hip fracture care Patient pathway Article 03 medical and health sciences 0302 clinical medicine process improvement interdisciplinary working Patient experience medicine Humans Pain Management 030212 general & internal medicine Lean Six Sigma Hospitals Teaching Aged Aged 80 and over Hip fracture business.industry Delivery of Health Care Integrated Hip Fractures 030503 health policy & services Health Policy Public Health Environmental and Occupational Health Nerve Block General Medicine Emergency department integrated care pathways healthcare outcomes Length of Stay medicine.disease Orthopedics Treatment Outcome Geriatrics Physical therapy Performance indicator Presentation (obstetrics) 0305 other medical science business Ireland Total Quality Management |
| Zdroj: | International Journal for Quality in Health Care |
| ISSN: | 1464-3677 |
| Popis: | Objective To improve access for hip fracture patients to surgery within 48 h of presentation to the Emergency Department, and to increase the number of patients receiving pre-operative orthogeriatric review, through streamlining an existing hip fracture patient pathway. Design A pre–post design involving a multi-disciplinary team use of the Define, Measure, Analyse, Improve and Control framework integral to Lean Six Sigma (LSS) methodology, to assess and adapt the existing hip fracture pathway from presentation to Emergency Department to the initiation of surgery. Setting A 600-bed teaching hospital in Ireland. Participants Nursing, medical, administrative and physiotherapy staff working across Emergency Medicine, Orthogeriatrics and Orthopaedic Specialities and Project management. Interventions LSS methodology was used to redesign an existing pathway, improving patient access to ortho-geriatrician assessment, pain relief and surgery in line with the Irish Hip Fracture Data Base Key performance indicators. Main Outcome Measures Access to pain relief, access to surgery and volume of patients receiving ortho-geriatric assessment. Results The percentage of patients undergoing surgery within 48 h of presentation to Emergency Department increased from 55% to 79% at 3 months, and to 85% at 6 months. Improvements were also achieved in the secondary performance metrics relevant to quality of patient care. All care pathway changes were cost neutral. Conclusions Hip fracture surgery within 48 h of presentation to hospital is a recognized standard of hip fracture care associated with decreased length of stay and decreased mortality. With respect to this performance metric, this intervention has contributed to improved patient outcomes. |
| Databáze: | OpenAIRE |
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