A UHSussex multi-disciplinary team from emergency floor to orthopaedic surgeons have been praised at Worthing Hospital for their efficient care of patients with hip fractures.
The National Hip Fracture Database, a national programme, have recognised that the hospital is performing above average in assessing these patients in A&E, administering a nerve block to treat pain, and quickly admitting them to an orthogeriatric ward within four hours of arriving.
This impressive performance is the result of excellent collaborative working from healthcare professionals across the hospital who have come together to form a Hip Fracture Working Group, dedicated to improving patient care and driving change. This work is a result of our Patient First approach, as staff transform our services for the better and continually aim to improve performance.
This multi-disciplinary team is made up from the paramedics who first bring these patients to A&E through to specialist wards, matrons, theatre and recovery staff, orthogeriatricians (care of elderly orthopaedic inpatients), orthopaedic surgeons, anaesthetists, inpatient pain service, physio, and occupational therapists.
Early recognition of a hip fracture is key, which is how the team at Worthing learned that swiftly placing patients on a specialist pathway can drastically improve their outcome. This includes less post-op delirium and earlier mobilisation and discharge. The impact of this work also received greater patient satisfaction and a reduction in complaints from patients and their relatives.
Inge Bateman, Lead Clinical Nurse Specialist Inpatient Pain Service, said: “When patients come to A&E presenting with a hip fracture, in the first instance we knew we wanted to make their experience as comfortable as we can for that person. To do that, placing them onto the specialist hip fracture pathway early gives them the care they need and greater chance of returning home, which really improves their quality of life.”
“This has only been made possible by a committed team with a common goal in improving patient experience. Everyone is motivated and that’s why it works. Their commitment makes a huge difference and is what drives change. That is how we were able to achieve the incredible results we have.”
Last year, over 500 patients were treated at Worthing Hospital with this injury. Broken hips are typically seen in older patients who are frail. These patients can have problems with memory, language, thinking or judgment.
Treating them earlier helps prevent the risk of deep tissue injury and pressure damage from laying on a trolley for too long, as well as dehydration. Also, using opioid sparing techniques and administering nerve blocks early to target and improve pain has proven to help reduce the side effects of opioids, including delirium.
Eileen O’Connell, 78, from Worthing fractured her hip after losing her balance at home. She was brought to Worthing hospital where she had surgery for a partial hip replacement.
Eileen said: “The ambulance got me to A&E fast and from there they got me seen to quickly and I was up onto this ward. I felt once I got to hospital, I was well taken care of. Now I’m looking forward to going home and moving forward with my recovery.”
The team also recognised that small and simple changes can make a difference, such as implementing a hip fracture bleep. Once sounded, staff are alerted there is a patient in A&E with a suspected fracture. Here, early intervention is initiated, including preparing a bed on the orthogeriatric ward with an inflatable mattress, ready for their arrival.
Carmina Montefrio, Ward Sister said: “When my team get that bleep, they know what they need to do. I’m so proud that their hard work is getting recognition. We knew this group of patients needed to be treated more quickly. Patients were spending too long in the emergency department and now they are coming up to these orthogeriatric wards faster to receive the specialist help they need.”
