THE QI JOURNEY
Neck of Femur Fracture Patient Pathway
Over all Aim of the Quality Improvement Programme
"TO DELIVER OPTIMAL MANAGEMENT OF ALL PATIENTS WITH FRACTURE NECK OF FEMUR TO ENSURE THEY RECEIVE BEST QUALITY CARE WITH MAXIMAL RETURN TO HOMELY SETTING IN SHORTEST NECESSARY TIME WITH NO HARMS"
(harms =AKI, CAUTI, DELIRIUM, PU, VTE, SSI, DEATHS)
The first part of our Quality Improvement Journey involved working with multidisciplinary teams to create a diagram to describe what happens to the patients, where it happens and who is involved. The High Level Process Map demonstrates the process from the patient presenting in Emergency Department through treatment and the acute phase of care to discharge.
FOR THE PURPOSE OF THIS PROJECT WE HAVE DIVIDED THE CARE PATHWAY INTO TWO WORKSTREAMS.
THE OVERALL AIM OF THE PROGRAMME IS LINKED TO PRE-OPERATIVE FACTORS THAT THE TEAM BELIEVE HAVE A DIRECT IMPACT ON THE PATIENT CARE PATHWAY:
- OPTIMAL PRE-OPERATIVE CARE AND
- EARLY FRACTURE FIXATION
THESE FACTORS ARE THE PRIMARY DRIVERS TO ACHIEVE IMPROVEMENT.
The following opportunities have been identified as areas where work can be done by the team. These are the Secondary Drivers for Pre-Operative Care which will contribute to the overall aim.
Activities will focus on:
THE OVERALL AIM OF THE PROGRAMME IS LINKED TO OPTIMAL POST OPERATIVE FACTORS THAT THE TEAM BELIEVE HAVE A DIRECT IMPACT ON THE PATIENT CARE PATHWAY:
- EFFECTIVE RELIABLE MOBILISATION
- DISCHARGE PLANNING
THESE ARE THE PRIMARY DRIVERS TO ACHIEVE IMPROVEMENT.
The following opportunities have been identified as areas where work can be done by the team. These are the Secondary Drivers for Post-Operative Care which will contribute to the overall aim.
Activities will focus on:
A driver diagram - also referred to as an action effect diagram was created by the team as part of the the initial planning, it is a visial representation of the teams theory of change and describes their understanding of how the system and the pathway work towards the overall aim.
The Diagram sets out what changes will likely cause the desired effects and contribute to the overall aim and defines the specific changes or interventions that will lead to the desired outcomes which are the key drivers.
The Driver Diagram will serve as a tool - it will be updated regularly by the team to refine the theories of improvement and defining which aspects of the system should be measured and monitored. Our next stage is to see if the changes/interventions are effective, and if the underlying causal theories are correct.