BC Hip Fracture Redesign Project CATCHING THE WAVE Presentation to Collaborative Committee Showcase February 24, 2016
BC Hip Fracture
Redesign Project
CATCHING THE WAVE
Presentation to Collaborative Committee Showcase
February 24, 2016
OVERVIEW of Presentation
Background / Context
Goals & Objectives
Baseline Survey & Identification of Gaps
Priority Areas for Focus of Best Practices
Project Data Collection & Measurement
Improvements made
Legacy work
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Background / Context
Significant burden on health – high personal
and system costs
Priority population for government
Purposeful alignment with parallel initiatives
(e.g. ERAS, 48/6, Care Sensitive Adverse
Events, Safer Healthcare Now, Polypharmacy)
Consistent with BC Health System Strategic
Directions Document
National Best Practice Tool Kit defined
Canadian Standards
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Why focus on hip fracture care?
▪ Approx. 4,000 in BC have a hip fracture each year
▪ 22% will be back in hospital within 90 days
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Project Goals
Improve Patient Experience & Outcomes
Innovative, evidence-based clinical practices
Improved access to surgery
Lower mortality rates & complications
Improved patient flow
Reduced length of stay in acute care
Improved collaborative practice & transfer of care
Improved patient engagement in the care pathway
Data-driven change management 5
Hip Fracture Redesign Project
Funded by SSC
Phase 1: Pilot Project (8 sites)
Phase 2: SPREAD to additional 20 sites around BC
Add-on: Polypharmacy Risk Reduction Pilot in 3
surgical sites (Shared Care funding)
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Regional
level
Levels of support
Local site
Regional / HA
Provincial coordination
Local
site
Provincial level
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Approach
▪ Conduct baseline survey to review care & priorities for
improvement in 28 BC hospitals
▪ Engage surgeon, clinical and operations leads
▪ Map the patient journey
▪ Develop data collection tools and processes
▪ Implement standards of care and tools to support best
practices
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Mapping the Patient Journey
Prevention
Bone &
Falls
Hip
Fracture
~3900 / yr
(28 sites)
Transfer Admission Assessment
Procedure
POST-Op
Care
D/C
Planning
Home
New Facility
Same Facility TCU?
Bottlenecks
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Goals for Ideal Patient Journey
Prevent/minimize person-specific
complications thru proactive care
Maximize functional recovery
Maximize self–care management
Ensure appropriate follow up care
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Gaps in Care from
28 Hospital Survey
Project Response
Complications, morbidity,
LOS from delays to
surgery
Time to Surgery - within
48 hours of hospital admit
Surgery delayed due to
anticoagulation
Evidence-based Reversal
Guidelines
Pre-op & post-op best
practice gaps
Evidence based
provincial order sets with
supporting rationale
Timely, self-management
support for patients /
families
FRESH START Tool kit for
patients/families & care
givers 11
Gaps in Care from
28 Hospital Survey
Project Response
Staff, patient, & family
education & engagement
Project website, posters &
patient pathway
Lack of care coordination
Tools to facilitate
transitions/hand-offs in
care
No data on process &
outcome indicators to
support change
Minimum data set to track
key measures pre-post for
change analyses
Multiple meds leading to falls,
delirium, complications,
readmits
Polypharmacy Risk Reduction
(Partner with Shared Care) in 3
pilot sites
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▪ High functioning inter-disciplinary team of clinical leaders
from each health authority. Patient representatives
included
▪ Model of accountable care – focus on foreseeable risks
▪ Aligned with: ERAS, 48/6, Safer Health Care Now, Poly-
pharmacy Risk Reduction
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Best possible medication history & reviews upon hospital admission
Medication reviews / adjustments at touch points in collaboration with team/patient/family
Patient/Family medication management support
Clear discharge recommendations for patient, family, GP & pharmacy
Poly pharmacy Risk Reduction Interdisciplinary team uses QI
methods to determine how to do:
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Pre-printed Orders with
Rationale Document
▪ Template orders developed collaboratively with
health authority leads and surgeons
▪ Succinct rationale document with evidence to
support orders
▪ Site based stakeholder teams to customize, approve
and implement orders per HA processes
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Goals:
- Improve the patient experience & reduce readmissions
- Support patients /families to manage their care
Evidence based:
- Coleman’s model
- Safer Health Care Now
- Local research
In Punjabi & Chinese too
www.hiphealth.ca/research
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Dr. Maureen Ashe CIHR funded researcher. Formed
Initial Fresh Start team
Dr. Pierre Guy, Dolores Langford, Karen Tsui
Validated with 30 patients/families. 9/10 for usefulness.
Published: Patient Preference & Adherence. Sept 2015 Exploring older adults’ perceptions of a patient-centered
education manual for hip fracture recovery: “everything in one
place”
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Fresh Start Booklet
Prepares Patients/Families
▪ Understand their fracture, surgery & recovery
▪ Play an active role in preventing foreseeable risks e.g.
pneumonia, UTI, pain, falls etc.
▪ Know how/where to identify & communicate care needs
▪ Obtain equipment & support for home safety
▪ Recognize red flags & what to do
▪ Understand medication issues & safety requirements
▪ Arrange follow up appointments
▪ Undertake safe exercise
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Preventing foreseeable risk in hospital.
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Customize to patient Home Safety/Setup
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Staff/ patient collaboration to improve experience &
outcomes with a successful return home
22 http://www.hiphealth.ca/media/FReSH%20Start%20Manual_FINAL_Webready.pdf
Suggested standards for
Rehab Intensity
▪ Varies by discharge destination: home,
convalescent/ TCU, rehab, residential
▪ Formal and informal supports
▪ Assistive devices/equipment
▪ Early mobilization within 24 hrs post-op with
continuation of physical therapy @ 12 week,
6 months, and beyond for maintenance
▪ Self management skills & caregiver
education
▪ Use of 1:1 treatment and groups 23
Strategies for Improving
Access to Rehab ▪ Fresh Start booklet & SAIL program
▪ Phone follow up by a health care professional
▪ Utilization of home support & rehab assistants
▪ Knowledge of community resources - checklist
▪ Telehealth, video conferencing, phone coach
▪ Community-based group programs with
attention to transportation & access supports
Rehab Services
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Communication Checklists for
Care Transitions ▪ Key Transitions
▫ Admission through Emergency
▫ Discharge from acute care to home, convalescent
care, rehab, community or residential care
▫ Involvement of Family Physician / GP
▪ Inter-professional discharge checklists
▪ Patient/Family information
▪ Physician follow up
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