The Best Practice Tariff helps improve management of neck of femur fractures: a completed audit loop

Khan, Sameer K.; Weusten, Axel; Bonczek, Sandra J; Tate, Alan D.; Port, A.

doi:10.12968/hmed.2013.74.11.644

Cited by 28 publications

(23 citation statements)

References 6 publications

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“…Over a period of eight years, under consistent orthopaedic and geriatric leadership, the Hip Fracture Service significantly decreased surgery time from inception to presentation while maintaining the comparably low time to surgery from the emergency room, length of stay, complication rate, and mortality rate 33 . Other hipfracture multidisciplinary teams have also substantially decreased time to surgery, resulting in lowered patient mortality and a shortened hospital stay [34][35][36] .…”

Section: Reflectmentioning

confidence: 99%

Teaming: An Approach to the Growing Complexities in Health Care

Nawaz¹,

Edmondson²,

Tzeng³

et al. 2014

The Journal of Bone and Joint Surgery-American Volume

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Confronted with rising costs and patients who often have multiple comorbidities, the orthopaedic surgeon needs to face the challenge of providing high-quality health care. One solution is to increase and improve coordination, communication, and teamwork. The orthopaedic surgeon also needs to work effectively and efficiently to manage a fluid and shifting mix of health-care personnel partners from other disciplines and specialties to deliver high-quality patient care. The orthopaedic surgeon must collaborate in a new way with fellow health-care professionals, providing care by following teaming protocols.In the appropriate leadership role and employing the necessary motivational, communication, and conflict-management skills, the orthopaedic surgeon must build the proper foundations for teaming through the selection of compatible, effective team members and establish the necessary collaborative teaming environment. The orthopaedic surgeon needs to lead these teams and promote communication, listening, and collaboration. The emphasis on effective communication through a horizontal hierarchy rather than an autocratic management style by the orthopaedic surgeon allows the seamless incorporation of specialty physicians as needed and facilitates teaming among orthopaedic staff.With a facilitative environment and clear communications, teaming in patient care will occur as a learning cycle of diagnosis, design, action, and reflection. Each of these steps is critical for teaming to be successful. During diagnosis, the orthopaedic surgeon needs to effectively frame the situation. In design, the orthopaedic surgeon needs to encourage participation in the determination of the next appropriate steps for patient care. During the action step, teaming protocol emphasizes both the process of care through care-tracking and the result of that care, which is critical for reflection. Reflection is necessary for the team to improve its effectiveness and learn from its experience. However, for successful reflection and learning, the orthopaedic surgeon needs to be truly open to criticism.Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Section: Reflectmentioning

confidence: 99%

Teaming: An Approach to the Growing Complexities in Health Care

Nawaz¹,

Edmondson²,

Tzeng³

et al. 2014

The Journal of Bone and Joint Surgery-American Volume

View full text Add to dashboard Cite

show abstract

“…3 15 24 25 These indicators have subsequently been used in other health systems worldwide (eg, Australia, Canada and other European countries). [26][27][28][29][30][31][32][33] However, these indicators are focused solely in the acute care period and therefore do not measure the quality of care in the postacute care period.…”

Section: Introductionmentioning

confidence: 99%

Scoping review of potential quality indicators for hip fracture patient care

et al. 2017

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ObjectiveThe purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture.DesignScoping review.SettingAll care settings.Search strategyEnglish peer-reviewed studies published from January 2000 to January 2016 were included. Literature search strategies were developed, and the search was peer-reviewed. Two reviewers independently piloted all forms, and all articles were screened in duplicate.ResultsThe search yielded 2729 unique articles, of which 302 articles were included (11.1%). When indicators (eg, in-hospital mortality, acute care length of stay) and potential indicators (eg, comorbidities developed in hospital, walking ability) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures (process). There was heterogeneity in definitions within constructs between studies. There was also a paucity of indicators and potential indicators in the postacute period.ConclusionsTo improve quality of care for patients with hip fracture and create a more efficient healthcare system, mechanisms for the measurement of quality of care across the entire continuum, not just during the acute period, are required. Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the postacute period.

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“…There is clear evidence of improved care in the population with hip fracture due to units meeting the hip fracture BPT criteria with significant benefit in patient outcomes. 9,10 In order to achieve the extra financial benefit (£1335 per patient) of the top-up payment that is additional to the base tariff received by the hospital for a hip fracture episode, all domains of the BPT (including operation within 36 hours) for hip fractures must be met. The data for each case are reconciled through the National Hip Fracture Database (NHFD).…”

Section: Introductionmentioning

confidence: 99%

“Tiers of Delay”

Eardley

MacLeod

Freeman

et al. 2014

Geriatr Orthop Surg Rehabil

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Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. Basic demographics, time to theater, length of stay, and mortality were recorded for all patients. Independent samples t-tests were used to identify statistically significant differences between patients on warfarin and those not taking the drug. A total of 83 patients were admitted anticoagulated with a mean international normalized ratio of 2.65 and a median time to theater of 49.7 hours. Of these patients, 79% breached BPT, incurring significant financial loss. In the control group, 908 patients took a median 24.5 hours, a 28% breach of BPT (P < .01). Length of stay, Nottingham Hip Fracture Score, and predicted 30-day mortality were similar for both the groups. As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an ''early trigger'' anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.

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The Best Practice Tariff helps improve management of neck of femur fractures: a completed audit loop

Abstract: Focusing on poorly satisfied Best Practice Tariff indicators can produce a significant improvement in the per capita Best Practice Tariff achievement. Further studies are needed to assess the health and financial gain in detail.

Cited by 28 publications

References 6 publications

Teaming: An Approach to the Growing Complexities in Health Care

Teaming: An Approach to the Growing Complexities in Health Care

Scoping review of potential quality indicators for hip fracture patient care

“Tiers of Delay”

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