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The BMJ Patient Safety Team 2015

Interview with award winner Dominic Inman, chairman of the Hip Quality Improvement Programme.

“It’s about engaging the right people, making sure they get the right training, and giving real-time feedback in an encouraging way.”
- Dominic Inman, orthopaedic surgeon and chairman of the Hip Quality Improvement Programme

One in five hip fracture patients will not make it home, and 30% will die within a year. While there are many reasons for this high mortality rate, a very common situation is an elderly patient struggling to live on their own. Slowly they get worse and can manage less and less – until one day they fall. “A hip fracture may be a sign of not coping with their current circumstances. It is often the straw that breaks the camel’s back” according to Dominic Inman, orthopaedic surgeon and chairman of the Hip Quality Improvement Programme,  and winner of this year’s The BMJ Awards Patient Safety category.

Dominic Inman

In the last year alone, there were 70,000 admissions for hip fractures to 176 hospitals in the UK. The Northumbria Healthcare Foundation Trust’s Hip Quality Improvement Programme aimed to tackle this important problem through evidence-based clinical innovation across the entire healthcare organisation. Mr. Inman says, “if we can provide patients with timely surgery and get them back on their feet with good nutrition they may actually return safely to their living situation and remain there.” The project’s success relied on quality improvement, science and the Trust’s culture of keeping the patient’s emotional and physical needs at the core of change management.

Before the programme was implemented in 2010, hip fractures were seen as a fairly standard orthopaedic procedure, when in actuality they are associated with a high risk of dying. Mr. Inman recalls that, “the team knew they could do better” and decided to make systematic changes to improve outcomes for patients. The programme made changes that included: pain blocks in A&E, prioritising hip fracture patients for surgery within 36 hours, providing enhanced nutrition monitoring and assistance for elderly patients, and rapid mobilisation after surgery. These enacted changes increased the chances of patients recovering and returning home. Mr. Inman states, “it’s these simple things which we think make a difference.”

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Mr. Inman and his team sought buy-in from and provided training for all of the involved departments. The programme worked with perioperative staff to enhance patient nutrition and hydration, as evidence suggests that employing people to specifically help at mealtimes and offer snacks between meals can result in a 40% drop in mortality when compared with routine nursing care.

They also worked with A&E staff to explain the importance of elderly patients receiving a pain block instead of morphine, and trained them to be given as soon as a patient comes in. Now up to 90% of hip fracture patients get a pain block and the trust is in the top 5% in the UK for expediting patients into surgery. According to Mr. Inman “it’s about engaging the right people, making sure they get the right training, and giving real-time feedback in an encouraging way.”

In the future the programme aims to target high risk patients and provide added interventions, enhanced perioperative care, and upfront monitoring. “It really makes a difference if we can get things right on day one. Enhancing our care for this high risk group is our latest challenge.” National recognition from winning the BMJ Patient Safety Team award has built confidence in both clinical staff and management to extend and expand the Hip Quality Improvement Programme. Mr. Inman says, “it makes them realize that their hard work has paid off and it’s nice to feel like it is making a difference.”

Image from right to left: Dominic Inman, chairman of the Hip Quality Improvement Programme, Sarah Langford, trauma ward manager, and Paul Crabtree, a representative of KM&T.