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Modelling Prediction of Care Pathways

For patients who are post-op fixation of a fractured hip

Overview of the Project


Designated acute orthopaedic trauma service, managing a high volume of patients sustaining a fractured hip. Audit in August 2011 revealed that nearly half (44%) of these patients required referral for rehabilitation services. On average this referral was taking place at day ten postoperatively. Overall project aim was to identify, and utilise, predictive factors to rehabilitation need for patients sustaining a fractured hip, in order to proactively guide their appropriate pathway of care. Hypothesised that reductions in the length of time taken for appropriate patients to access rehabilitation settings would help to reduce acute length of stay.

formation of a new Trust pathway of care for management of patients with a fractured hip. One of this projects overall aims, therefore, has been to assist compliance with this pathway in the post-operative care phases. Sustaining effective leadership and progression of the project as the only static member of a team whose personnel change at least every six months.

Results
Predictive factors have been successfully identified, and
formed in to a working model. This predictor model has been successfully trialled with over 200 patients in a Plan-Do-Study-Act approach. Since the introduction of the predictor model the average day of post-operative referral to rehabilitation services has dropped from 10 days to 3.5 days. Daily MDT planning meetings also highly significant in effecting appropriate referrals in a timely manner. Acute hospital length of stay for this patient group has significantly reduced, from 22 days in August 2011 to an average of 11.8 days in August 2012.

Leadership Challenges
Two principle leadership challenges identified: Leading the project, and the in-patient orthopaedic physiotherapy service, in the context of a Trust-wide reconfiguration of orthopaedic services. This has included the

Contact Information
Peter Eckersley In-Patient Orthopaedic Physiotherapy Team Lead, North Manchester General Hospital Peter.Eckersley@pat.nhs.uk Work Telephone: 0161 7202425