Our vision was to provide integrated care of the highest quality within a culture of continuous learning, innovation and development. Adopting the Institute of Medicine’s definition of patient centred care, we aimed to transform key stages of the patient pathway. A large launch event with 140 participants ensured effective engagement from all stakeholders. We established a multidisciplinary audit framework (Quality Account) which outlined 12 deliberately ambitious standards.
We committed to measuring the right things, measuring well, measuring relentlessly and acting quickly. Our steering group met monthly to review progress against service goals. Multidisciplinary teams received weekly reports of their performance. Evidence suggested that prioritising additional nutrition for patients with hip fracture could lead to a reduction in our death rate. The surgical care bundle, pain block in A&E, surgery within 36 hrs and root cause analysis of every death were further measures adopted to reduce mortality. Training & support was provided to improve nutrition, pain management, information provision, early mobilisation and compassion at the point of care. Real time patient feedback was built into the local improvement strategy. Outcomes are reported to teams within 24 hrs of capture and also shared with patients, families and the public.
Results: •Trust wide 30 day mortality has improved from 14.3 % to 8 % - a 44% reduction. •Both our hospitals named as best in NHS for timely surgery in 2011 NHFD report – top 5 position maintained since then. •100% of medically fit patients are now mobilised by day 1 and 40 % on the day 0 (previously 4%) •90% now receive a nerve pain block on admission - Previously 0 % •97% of patients ( n = 384) believed we did everything we could to effectively control pain. •90% of patients now receive additional feeding each day from dedicated nutritional assistants. •Consistently excellent Patient Experience scores of above 95% across the domains of care that matter most to patients.
HIP QIP transformed the quality of our care and brought issues of safety and clinical effectiveness into the work of improving patients’ experience. Having staff authentically involved in driving service improvements alongside and through the eyes of patients gave us the best chance of rapid change. It has also enabled us to sustain and build on progress over three years, something that is notoriously difficult to achieve. 4 years on, we have significant improvements to share: our patients are now more likely to survive, have faster access to information, imaging, surgery, better pain management and early physiotherapy 7 days a week. We believe these results are fab and entirely replicable.