Burton patients receiving care ‘above national average’ for fractured hips
Consultants at Burton are now providing better care for patients with a fractured hip, according to national scoring data which shows patients receive better care and recover quicker at Queen’s Hospital Burton than in most other hospitals (better than the national average).
The Trauma and Orthopaedic team at Queen’s Hospital set up a steering group in May 2018 with consultants Mr Shyam Rajagopalan and Mr Amit Kotecha, alongside Trauma Coordinator Vicky Frost, to highlight areas where patient care could be improved by removing waste from processes to achieve a more streamlined and measured ways of working.
The group highlighted key areas which could improve outcomes for patients; providing Ortho-Geriatric Consultant support six days a week allowing patients to receive the right care in a more timely manner, ensuring that patients received physiotherapy on the same day or the day after their surgery, prioritising patients on consultant-led operating lists and ensuring delirium scoring is carried out post operatively which has a direct impact on patient mortality.
In 2017, the Best Practice performance for patients with hip fractures was below national standards at 39%, whereas the national average was 58%. However, eight months after the steering group was established, hip fracture care improved significantly which was reflected on our improved best practice tariff soaring to 76%, well above the national average.
This improved patient care translated to average length of stay reducing by almost three days, more patients are being operated on inside the first 36 hours and being seen by a physiotherapist sooner following their procedure.
Trauma and Orthopaedic surgeon and Trauma Lead, Mr Shyam Rajagopalan, said: “I really wanted to see us make improvements following our 2017 data. We knew there were things we could do to improve the care provided to patients. We made small tweaks to several areas of our work to ensure patients were receiving the best care in order to get them back up and about as quickly as possible.”
Fellow Trauma and Orthopaedic Consultant, Mr Amit Kotecha, added: “We looked at everything that was being done already but made sure it was done in the most robust, effective way, with limited amount of resources to get maximum output.
“We removed any waste from the patients journey to ensure patients received effective care as soon as possible, which has led to reduced length of stay, getting patients to theatre sooner and getting specialised care as soon as possible. All of this transpires into better patient outcomes which is of course the primary goal. We’re above national average now, and we were below this mark when we formed this steering group.
“For the eight month study period after these interventions, we calculated that we generated a new income of around £176,000 and saved £128,000 on bed stays as a Trust, which is a combined excess of £304,000. This will be reinvested back into our services.”
Seventy-three-year-old Valerie Ryan broke her hip in January 2019 and had a total right-side hip replacement as a result:
“I’d just got off the train and my foot gave way underneath me and when the paramedics arrived, they saw that my foot was at an angle and immediately told me I’d fractured my hip. I was admitted to A&E in Burton at 6pm and was then taken for my surgery at 9am the following morning.
“I was in total shock, and I live alone so all I could think about was how I was going to cope when I was sent home? But I owe massive thanks to all of the team. One year later and I wouldn’t even know I’d had the procedure.
“I didn’t think I’d be able to do it, but the physio had me up and about on the same day as my surgery and I thought I’d be in a lot of pain, but I wasn’t. I only ended up spending five days in hospital before being sent home, where the Occupational Therapy team had worked hard to adapt my home to make things easier for me in my recovery.”
Former nurse Valerie Harrower, also 73, also fractured her hip in November 2019 after falling down some stairs, and has thanked the team for all of their hard work.
She said: “After my operation, I was up very quickly which I thought was incredible, and the pain wasn’t as much as I had expected which was fantastic. The physio was full of praise for how well I was walking on just one stick the day after my operation. I spent eight days in hospital and I’m very grateful to the hospital staff.”
Mr Rajagopalan spoke of his delight at how the improvements the team has made has benefitted both Valeries’ recoveries: “It’s amazing to see patients making such recoveries – that is where we get the satisfaction for the work that we’ve done. It really gives us a lot of pleasure if patients can get back on their feet without any pain as soon as they can is all we want to see, and this is as a result of the combined effort of the whole team.”
Mr Kotecha also praised the team for all of their hard work: “Your sense of occasion in becoming an Orthopaedic surgeon is to help patients get up and about and when you see that in practice, it’s amazing. But it’s a reflection of the efforts of the whole team and to hear such patient success stories is what gives you the motivation to keep going.”
CEO Gavin Boyle said: “This is a perfect illustration of changing the way we work to improve patient care, and discovering ways that we can be more efficient.
“It is another fantastic example of services in Derby and Burton working closely together and how this mutual support had helped to accelerate the benefits that they’ve achieved.”