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Table 1 Key process improvements achieved through ValuedCare methodology

From: ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore

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