Aim The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and improve care in NOFF patients. Current practice across the NHS incorporates several different inpatient orthogeriatric models. Our quality improvement project sought to improve inpatient care delivered by orthopaedic staff with a geriatric targeted focus. Method An initial audit on 50 patients was conducted and key areas of concern were highlighted. A focussed proforma for daily reviews was implemented which encompassed local and national (NHFD) recommendations and this was re audited for a further 50 patients. Results Documentation of demographics, comoribidites and pre-operative social parameters improved from 70 to 100%. Examination of general health systems improved from 80 to 100%. Identification of nutritional abnormalities improved from 66 to 95%. Documentation of skin condition including wound care and pressure ulcers improved from 55 to 90%. Management of perioperative indwelling urinary catheters improved from 55 to 90%. Identification of unwell patients and thromboembolic risk assessments improved from 65 and 70 to 90 and 95% respectively. Conclusions Our targeted focused proforma facilitated an easy and comprehensive daily review for vulnernable geriatric patients. Additionally, it formed a basis for daily handover amongst juniors changing wards and was adopted formally and adapted for other geriatric services.

Aim The NHS Institute for Innovations and Improvement (NIII) has determined that a £7 million saving can be achieved per trust by improving theatre efficiency. With an increasing influx of admissions and trauma, alongside increasing trends pertaining to the pandemic and winter pressures, it is vital to optimise our patients’ journey. Method The journey of transition from pre-theatre to recovery was mapped and retrospective data on a single weekday theatre trauma list was collected over a one month stretch using ORMIS and 77 patients were identified and analysed. Results The average case load was found to be 3.7 cases with lowest case load during the end of the week. The average send time for a patient was documented to being 8:45 (range:8:15–9:934) with an average turnaround time being 65 minutes for the first case and 37 minutes for subsequent cases. The average knife-to-skin time was found to be 10:00 for the first case (range:9:21–10:34). The median intercase time (time take from the patient leaving theatre to the next patient entering theatre) was found to be 47 minutes (range:15–49). Conclusions Causes for delays in theatre flow were largely multifactorial and this impacted the first patient the most leading to a knock-on effect on subsequent patients on the list. With the NIII attributing an efficiency cost of £24.77/minute, there is a lot to be gained by maximising theatre efficiency particularly with current limited resources. A joint surgical and anaesthetic quality improvement project focusing on the golden patient was introduced with a patient focused approach.

Aim Plaster of Paris casts form one the most basic yet effective treatment for acute orthopaedic fractures and often form a permanent treatment methodology. Patients with fractures present at all times of the day to acute services and require prompt stabilisation. Casts however do present some risks including compartment syndrome and skin ulcerations. Our quality improvement aimed to improve confidence in healthcare providers across different specialities in managing plasters. Method Focussed workshops conducted by expert plaster technicians under the supervision of an experienced orthopaedic consultant were conducted for upper and lower limb injuries. Additional workshops encompassing plaster safety and other trauma splints were delivered. Candidates ranged across different grades and included nurse practitioners and qualified doctors. Confidence scores (out of five) measured on a Likert scale were obtained from 25 participants. Results Knowledge about plasters including type of plaster matched to injury improved from a mean score of 3 to 4.5. Confidence in applying upper limb plasters improved from a mean score 3 to 4.7 and applying lower limb plasters improved from a mean score of 3.25 to 4.8. Confidence in plaster safety including acute conditions and safe removal improved from a mean score of 2 to 4.6. Confidence in applying acute splints improved from a mean score of 1.5 to 4.3. Conclusions Our quality improvement project improve the confidence in practitioners managing acute orthopaedic patients with an emphasis on plaster safety and acute splints. It has been formally adopted on a regular basis as a teaching program.