Data analysis identified improving outcomes for anaemic patients as a quality improvement project. Clinical coding allowed comparison of outcomes for the first 3000 Enhanced recovery patients, 13% of which were anaemic. Anaemic patients have more comorbidities, are more likely to require a critical care admission, have higher transfusion rates and a longer length of stay. Anaemia is associated with unfavourable outcomes including stroke, myocardial infarction and death.
The Orthopaedic Anaemia Project aims to improve pathway efficiency and quality by optimising patient outcomes, reducing complications and readmissions. In February 2013 pre-operative anaemia screening was introduced for primary joint replacement patients. Through collaboration with haematology, orthopaedics, pathology, and GP clinical leads, an approved algorithm ensures patients are on the optimum treatment pathway. Bloods are taken on listing by the Orthopaedic surgeon or outpatient clinic team. Patients whose blood results indicate a mild anaemia and who may benefit from treatment are offered oral iron or IV iron depending upon their results and medical history. When patients’ results suggest low iron stores and borderline anaemia their GP is asked to prescribe a course of iron for 28 days. We have facilities at Wansbeck, North Tyneside and Hexham to administer IV iron treatment if needed. Repeat bloods are taken pre-operatively with most patients proceeding to surgery as normalA further blood test is required 6 months post-operatively to ensure we have not corrected anaemia caused by undiagnosed illness.
Patients with established anaemia (Haemoglobin < 115 Men or < 105 Women), are asked to make an appointment with their GP so that investigations can be undertaken. Surgery is postponed until the cause of their anaemia has been investigated and addressed.
Patients are given information to explain symptoms and causes of anaemia, the treatment we are offering, and advice about iron in their diet. If further advice or information is needed patients can can find further support via the Orthopaedic helpline.
Early anaemia screening and treatment makes efficient use of the waiting time from listing to surgery and reduces avoidable cancellations later in the pathway.
In the first year 257 (13.6%) of 1886 patients screened were anaemic. Of 197 who had surgery 133 were offered iron treatment, 38 were referred for investigations and 29 were reviewed by a haematologist.
Length of stay for this population has reduced from 4.00 to 3.64 days. Over a year this equates to a saving of 792 bed days per annum, costed at £317K.
Readmissions fell from 6.46% to 0.19% and the transfusion rate reduced from 7.60% to 3.15%.
Using interdependent working this partnership collaborated across directorates with a clear aim to improve patient care by introducing a multi-speciality approved innovation. The numerous key stakeholders combined diverse perspectives, and provided better quality care for less through rigorous scrutiny of ideas and shared decisions. For further information contact [email protected]