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ERAS: recovering faster from a broken hip

ERAS: recovering faster from a broken hip

Enhanced Recovery After Surgery (ERAS) - improving the neck of femur patient journey


This is an update on a story that we featured in our Quality Account 2013/2014 [view previous story about our ERAS project]


Why is improving the fractured neck of femur patient journey important?

More than 360 patients come to our hospitals with a fractured hip each year and this is increasing as our population ages. Older people are more at-risk of falls and fractured hips can be a serious consequence, particularly when combined with loss of mobility and independence.

Studies have shown that delaying surgery for repairing a fractured neck of femur has a huge impact on recovery and overall health outcomes. Waiting more than 48-hours has shown to more than double the risk of complications after surgery such as pneumonia, urinary tract infections, deep vein thrombosis and pulmonary embolism.

Enhanced Recovery After Surgery (ERAS)

We are part of a national improvement programme called Enhanced Recovery After Surgery (ERAS). The basic principles of ERAS are to ensure that patients:

  1. are in the best possible condition for surgery
  2. receive excellent care before, during and after their operation
  3. receive appropriate rehabilitation to help them recover as fully as possible

Our aim is to identify areas for improvement and implement changes to support these basic principles and get patients back to their normal activities as quickly as possible.


Did we make a difference?

Project update for 2014/2015

All of the improvements identified in the project have been delivered, and we have seen some great results:

Goal

Baseline Results

Mar 2015 Results

90% of patients receive surgery within 48-hours of presentation

75%

87%

90% active weight bearing within 24-hours post-operatively

22%

60%

90% managed according to an agreed anaesthetic protocol

n/a

100%

90% managed according the an agreed PONV protocol

22%

94%

90% managed according to an agreed discharge based criteria

n/a

94%


These improvements to the quality of care we provide have also:

  • reduced the average length of stay for our patients from 22.4 days to 19.8 days, a reduction by 2.6 days (12% decrease)
  • reduced the average hours to mobilisation from 41 hours to 27 hours
  • reduced time between surgery and going onto the rehabilitation (AT&R) ward wailing list from 5.8 days to 3.9 days (33% decrease)

Feedback

Staff have also really enjoyed the impact that these improvements have made:

"Last week I reviewed two patients on day one following a repair of their fractured neck of femur, both were following the ERAS protocol. I was amazed, one lady was 92 and the other was 87. They were both up and out in a chair and sitting up having their breakfast.

I was there to review their pain. Both were comfortable and happy and one wondered why I had come as she said had been so well looked after and had no pain. This is such different picture to what we used to see. Most patients were still in bed and often still attached to a PCA (pain pump) and IV fluids.

I was amazed at the difference and how it has such an impact for the patients and their well-being. Keep up your amazing work and your support for the amazing Nurses of ward 7. You are truly making a difference!" - Clinical Nurse Specialist, Acute Pain Team

Ward 7 (Home Ward) nursing team celebrating success of pilot
Ward 7 (Acute Home Ward for fractured NOF) nursing team celebrating success of pilot

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