Rehabilitation Following Hip Fracture; How Data Can Drive Service Development and Improvement

Purpose

The Scottish Standards of Care for Hip Fracture Patients were developed in 2014 to improve quality of care and outcomes for patients, by reducing the national variation in practice. Standard 8 Physiotherapy (PT) Assessment and mobilisation; Standard 9 Occupational Therapy (OT) Assessment relate to therapy interventions specifically. The standards were updated in 2018 with both therapy areas remaining unchanged.

NHS Fife performed poorly in relation to standards 8 and 9 in 2014. Only 39% of patients were mobilised by the end of day one, with 83% having a PT assessment by the end of day 2 and 55% having an OT assessment by the end of day 3 post admission.

The primary objective was to increase the percentage of patients achieving standards 8 and 9 to 100% for PT and OT assessment and 90% for mobilisation.

Only 39% of patients
were mobilised by the end of day one.
Using standards to drive improvement...
82% of patients were mobilised by the end of day one

Approach

NHS Fife took a strategic decision to develop a stand alone hip fracture ward and separate these patients from other trauma orthopaedics. Utilising the Model for Improvement, several PDSA cycles were undertaken to trial different models of working, including different shift patterns and skill mix. Once completed and analysed a business case was submitted requesting additional registered and non-registered staffing to support 5/7 day working. The non-registered staff would be dual trained to provide both Physiotherapy and Occupational Therapy assessments and interventions. This project incorporated agreed outcome measures; time to mobilisation, time to assessment (PT & OT) as well as length of stay and discharge destination.

Outcomes

The service has significantly improved in relation to standards 8 and 9. Currently 82% of patients are mobilised by the end of day one, 100% have a PT assessment by the end of day two and 81% have an OT assessment by the end of day three. The data shows that 62% of patients return to their original residence, and there is an increase from 40% to 91% of patients discharged within 14 days or less. This project has delivered service improvement and now provides an equitable quality of care to patients over the 7 days of a week, with improved and positive outcomes.

Implications

Undertaking this service improvement project has allowed staff to challenge the skill mix and practice of the profession, to ultimately deliver an improved and more responsive service to a particularly vulnerable group of patients.

This initiative has had implications across the acute therapy services, where skill mix and skill sharing is now being explored across a number of specialities, to develop and support a more flexible working model as we move into the future. This will in turn allow the service to better cope with the demands placed upon it by demographic and societal changes.

Fund acknowledgements

This work was not funded. 

Additional notes

This work was presented at Physiotherapy UK 2019.