West Midlands - From the Back to the Future: Overcoming the Challenges of Being an Outlier. A Multidisciplinary Team Approach to Quality Improvement for Hip Fracture Patients.

From the Back to the Future: Overcoming the Challenges of Being an Outlier. A Multidisciplinary Team Approach to Quality Improvement for Hip Fracture Patients.

Authors: Joyce Bradley (Head of Quality Improvement) Trust: WHT

In 2018, Walsall Healthcare NHS Trust was identified as a negative outlier in the National Hip Fracture Database, with an adjusted case mortality rate of 11.3% compared to 6.1%. In effect the pathway for fractured neck of Femur was…. broken.

During 2019 an MDT which consisted of Senior House Officer, Advanced Clinical Practitioner, Physiotherapist and T&O Consultant embarked on a Quality Improvement (QI) project to improve hip fracture care.Initially their aim was to reduce the mortality rate to below national average, but they needed to identify what was causing the problems. Analysis revealed concern in 3 areas: time to theatre, early patient mobilisation, and prompt delirium assessment.

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The MDT members completed a series of PDSA cycles, making small improvements in all three areas. They completed fishbone and driver diagrams which helped identify specific factors leading to poor clinical outcomes. This systematic approach avoided overlap in improvement cycles and ensured that they did not try to change too many things at once and could see the benefits from their changes. And things were looking up, improvements in the three areas were being seen and the Trust’s position on the national fractured neck of femur database was moving forwards.

In 2020, a challenging pandemic year, 9% more patients underwent prompt surgery with a reduced average time from admission to theatre, aligning with the national average. Physiotherapist assessment the day after surgery improved by 7% and 99.7% of patients underwent 4AT delirium assessment. By April 2020, the Trust mortality rate was 7.6%.

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The QI methodology combined with an MDT committed to small, consistent changes has reduced mortality and improved KPI’s. The team achieved its aim and have been work towards sustaining and making more improvements for a better, brighter future. In July 2021, the team submitted posters to the QI Awards event at the Trust, an overarching poster, and separate posters for the three areas previously identified.The independent judges scored the overarching poster the overall winner of the QI Awards.

And they did not stop there! The team have continued to look at other elements they can improve, applying consistent QI methodology, engaging their stakeholders, and measuring their data over time to see the improvement. Clinical Audits were used as a tool to study the overall outcome as well.

The team has been nominated in the Healthcare Quality Improvement Partnership (HQIP) Influencing Change Hero awards the results of which were announced on 15th June 2022 – and… Yes! They were successful and have won the award, the amount of improvement, the level of involvement and the better experience for patients is fully deserving of this national recognition and there is no sign of them stopping there, they continue to see what other improvements they can make and ensure they are sustained.

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Congratulations to the Team, a well-deserved award to recognise all the work that they have undertaken. Bravo!

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