The BMJ Awards 2018: Emergency Care Team of the YearBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1520 (Published 10 April 2018) Cite this as: BMJ 2018;361:k1520
- Nigel Hawkes, freelance journalist
- London, UK
Accelerated fractured hip
Improving the quality of care in hospitals in special measures is demanding, the more so as there is often a legacy of unsuccessful reforms. At Medway NHS Foundation Trust, says emergency medicine consultant Ashike Choudhury, previous attempts to improve the care of patients with fractured hips had failed.
Despite a succession of different internal pathways aimed at improvement, the mortality rate remained at 11.2%, against a national average of 8.4%. A nurse specialist was responsible for the existing pathway, working between 8 am and 4 pm, Monday to Friday, but 60% of the patients arrived at the hospital outside these hours.
A working group representing all the specialties decided to focus on a “safe” subgroup of patients who could be moved to the orthopaedic ward without getting trapped in the overcrowded emergency department. A bold move was to create a group of associate practitioners (band 4) trained to drive the pathway. Initial doubts that they would be sufficiently qualified were countered by building in many checks, and this has worked well. Patients are met at the door, greeted by name, triaged, and processed quickly. “The waiting time is down to 90 minutes, from 8 to 10 hours,” Choudhury says.
Mortality rates have halved to 5.7%, a striking result because a 25% increase in presentations of broken hips has meant that time to theatre has not diminished. “The accepted wisdom is that reducing time to theatre is the key,” he says. “That hasn’t reduced, but results have improved, which seems to show that other things are more important. That’s …