Table 1 Key process improvements achieved through ValuedCare methodology
Objectives | Pre-intervention | Post-intervention |
|---|---|---|
Early surgery within 48 h | Anaesthetic guidelines appended in pathway not used routinely | Orthopaedic team identifies and lists patients for early surgery with the use of anaesthetic checklist upon clerking |
Investigations ordered by the accident and emergency department (A&E) and the orthopaedics team, resulting in missing or duplicate orders | A&E doctor commences investigation order set to facilitate orthopaedics team in review and listing for surgery | |
Delayed review of early surgery rates | 2 weekly multi-disciplinary review of early surgery rates and documentation of reasons for delayed surgery | |
No dedicated high dependency (HD) beds for post-operative care, causing surgical delays | 3 dedicated HD beds for ValuedCare patients | |
Reduce complications | DVT prophylaxis starts from ward admission | DVT prophylaxis starts from A&E |
Ad hoc prescribing of pain, bowel medications, supplements and antibiotics | Standardized electronic orders used by orthopaedics team Medications reviewed by ortho-geriatrician and pharmacist | |
Restore patient’s functional ability to pre-fracture state | (Post-operative day 1) POD 1 mobilisation by physiotherapist not tightly enforced | POD 1 mobilisation by physiotherapist actively tracked and enforced |
Patient outcome measures acquired only from inpatient stay | Expanded patient outcome measures acquired from both inpatient, outpatient clinic and community hospital over 1 year post-surgery | |
Enhanced information flow and collection | Manual workflow in documentation with subsequent transcribing to electronic | Electronic documentation in organizational electronic medical record (EMR) system Real-time best practice elements compliance dashboard |