Improving hip fracture pathways

The journey –

This very successful project aimed to reduce time from A&E to theatre and improve pain control for hip fracture patients. It reviewed and revised the patient pathway through the system from paramedic through A&E, radiology, theatre, ward and discharge, including social care.



There have been a number of significant improvements including extremely positive patient feedback.  The team has recorded impressive reductions in, for example, pain score on movement from severe (2.75) to mild (0.5); median time to theatre (48 hours to 19 hours) and an increase in the percentage of patients treated on the day of injury (3{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} to 33{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}).  Although cost reduction was not a primary aim, the programme has led to a reduction of 1,800 bed days per year, saving an estimated £326,000.  There is also some evidence of reduced post-discharge dependency and therefore a reduced social care cost.

Other intended and unintended benefits have included improvements in staff morale; theatre and ward productivity; a reduced backlog on trauma board; and the development of a screening tool for malnutrition.  However, the programme team believe that the most significant change is cultural and behavioural.


Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems   X


Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health Long-term conditions End of life


Information, tools and techniques used

A small multidisciplinary team of anaesthetists, nurses, surgeons, and a clinical systems engineer worked together, with other professionals drawn in as required to help.  The project applied Lean Thinking and Enhanced Recovery principles, involving all professional groups and patients in the redesign. The team developed an innovative technique of clinical process simulation during which the process of care was simulated by the professionals involved from injury (with a paramedic) to ward. This technique has been used for another Trust’s team and could be offered to others who are interested.



This programme involves South Devon Health Services (primary and acute care) and social care. Interest from many other health systems has generated visits from clinical teams across the UK



Approximately a year was spent defining and analysing the problem with testing of ideas for change and building the will for change. The change in process occurred in November 2010 and is sustained with regular team review of success and issues to fix; they are proud of what has been achieved and striving to improve still further.


Contact details and further information

Andrew Fordyce:

Posted on Jan 16th, Cat: , , , Tags: , Comments: Comments are off for this post

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