To Reduce Length of Time to Post Discharge Therapy for Fractured Neck of Femur Patients (#NOF)

Qualiy Improvement Poster Download

Background & Problem

NICE recommendation: Patients should be able to continue an uninterrupted rehabilitation programme when they return to their own homes.

The ‘Hip Sprint’ audit (Chartered Society Of Physiotherapy 2017) found post ward discharge #NOF patients nationwide could wait one month+ before starting home rehabilitation. Anecdotal evidence on Ward 3A suggested patients could be waiting similar lengths of time. This was supported by baseline data: average wait 31 days (median 22 days)

Aim

To minimise deconditioning of patients and to return them to a quality of life acceptable to the individual in a timelier manner the therapy service aimed to: Reduce the time between discharge and follow up by the therapy service for #NOF patients to less than 2 weeks by June 2019

Potential additional impact: reduced length of stay (LOS) (with related financial implications) due to more positive risk taking by ward staff (i.e. whether patients would be found to be sent home earlier safe in the knowledge they would be seen sooner)

Method

Changes were tested in order to allow ward based therapy staff to visit patients in their own home.

Specific criteria needed to be set due to no additional funding being available for the project to prevent any negative impacts on the current inpatient service. The patient would need to:

• live within 15miles of GRH
• be able to follow simple instructions
• previously mobile & independent +/- an aid pre #NOF

Baseline data was collected followed by collection of the same data for the duration of the trial of changes

Results

Discharge to follow up: Baseline: 31.2 days average (median 22 days)

• Trial: 7.8 days (median 8 days, max 10 days)

8/10 patients achieved outdoor mobility, improved quality of life (patients reported now being able to attend various pre-booked appointments and social activities)

LOS: Baseline 12 days

Trial 9.8 days

2.2 days reduction in LOS, average cost saving of £8800 for the ten patients seen in the trial.

Implications

The trialled changes to the service achieved the aim of allowing patients to be seen within two weeks. During the trial there were no measured negative impacts on GHNHSFT ward based services. LOS reduced by 2.2 days with £8800 average cost saving for the Trust.

The therapy service would like to extend this trial to measure the impact on a greater number of patients.