A team of doctors at Somerset NHS FT have introduced a new way of managing patients who are recovering from a fractured neck of femur – with great results.
Somerset NHS FT tend to see about 500 patients with a fractured neck of femur and unfortunately in the UK one in 17 of these patients will die within 30 days.
Dr Stephen Harris, our consultant in intensive care and anaesthesia, Dr Oliver King, our FY1, and Dr Pat Walker, a CT3 in anaesthetics, who has since moved on to another NHS trust as part of his rotation, used our trust’s improvement methodology to develop ways to improve the experience of patients with a fractured neck of femur.
They carried out a snap audit in November 2019 that looked at how many patients developed hypotension after an operation, and the reason why.
For example it could be that the anaesthetic is still wearing off or the patient may need some extra blood pressure support, which can only be given in our high dependency unit (HDU) or intensive care.
The team found that hypotension was common, and that patients were therefore at risk of developing other complications, such as acute kidney injury.
With these findings in mind, the team developed three main aims for the quality improvement project:
1) To standardise the management of post-operative hypotension in patients who are recovering from a fracture neck of femur
2) To determine the impact on the number of HDU beds used and whether patients could be admitted there after their operation
3) To check whether there was any impact on the number of patients with acute kidney injuries, their length of stay in hospital and how soon they could be fully mobilised again.
Dr Harris said:
“We wanted to develop a pathway that empowered colleagues in our post-operative care unit to feel confident in managing patients, with a clear way of escalating if needed, particularly out-of-hours.
“We monitored the new standardised pathway over a year and found that the number of patients with post-operative acute kidney injury who were transferred back to the ward fell from 14 per cent to just under 5 per cent.
“We also found that none of the 18 patients admitted to HDU had an acute kidney injury.
“The feedback we’ve heard from colleagues involved in the recovery of patients was outstanding, with 100 per cent reporting that they felt the standardisation had led to a positive impact on patient care.
“Colleagues also told us that their confidence had increased by 21 per cent and they had a greater awareness of the management of post-operative hypotension.”
In conclusion the standardisation of care has introduced clear lines of responsibility and has empowered recovery colleagues to speak up and develop confidence in seeking an urgent medical review for their patients.
There has also been a clear reduction in the number of patients with an acute kidney injury following surgery, while having no impact on the number of beds available on our HDU.
Pictured (left to right) are: Rose Johnson – Staff Nurse, Kimberley Bradford – Support Practitioner, Sarah Domone – Junior Sister, Leti Bovinelli – Staff Nurse, and Dr Stephen Harris - Consultant in Intensive Care and Anaesthesia.