Specialty Centres - CASE STUDY: Orthopaedics at Sutherland Hospital
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Transcript of Specialty Centres - CASE STUDY: Orthopaedics at Sutherland Hospital
Fiona Lendon
Nurse Manager, Perioperative Services
The Sutherland Hospital
November 2012
The Sutherland Hospital Orthopaedic Centre
Vision
To encapsulate a persons care under a multidisciplinary
framework of services from diagnosis, through to
surgery, rehabilitation and follow-up.
Sutherland Shire Demographics
Southern Sector estimated population size, by LGA, 2011
Major hospitals in South Eastern Sydney
Tom Ugly’s Bridge
Sutherland Hospital largely services
the local community
Sutherland Hospital separations, by place of residence,
% total, 2010-2011
Illawarra-Shoalhaven
region: 3.7%
Sutherland Shire
LGA: 83%
Bankstown LGA: 1%
Canterbury LGA: 1%
Hurstville LGA: 2%
Kogarah LGA: 1.5%
Rockdale
LGA: 3.4%
Source: FlowInfo v11.2
Exclusions: SRGs:
chemotherapy, renal dialysis,
unqualified neonates
Other:
4.4%
Age Demographics of the Sutherland Shire
The Sutherland Shire population is ageing
rapidly
0.00 – 20.0% growth
20.1 – 40.0% growth
40.1 – 60.0% growth
60.1 – 80.0% growth
80.0 – 100.0% growth
65 – 74 years 75 – 84 years 85+ years
SUT: 50%
growth
38%
growth
97%
growth
HUR: 34%
KOG: 30%
ROC: 30% 21%
18%
32% 50%
19%
40%
Source: NSW Health Population Projection Series 1.2009, Department
of Planning & Statewide Services Development Branch, NSW Health
Projected population growth, by Southern Sector LGA, ten-year aged cohorts,
2006-2026
Background…
0
50
100
150
200
250
300
350
400
2005 2012
Knees
Hips
In March 2006 South East
Sydney elective joint
replacements taken over by
The Sutherland Hospital
Joint Replacement Surgery
So how do we manage
an extra 200+
arthroplasties per year
within existing
infrastructure
Work Smarter (and
harder)
Pre-Admission Assessment Clinic
Multidisciplinary
One stop shop
Referral to other
clinicians and
services
Patient Information Booklets
Booklets available
in the top 7
languages spoken
in the LGA
While -You -Wait
OsteoArthiritis Chronic Care Program
(OACCP)
Direct referral to the
clinic via the
patients GP
Or
Referred once
entered onto the
waitlist
Allied Health
involvement
Follow-up for 6
months
ELECTIVE vs. EMERGENCY
ELECTIVE
Monday to Friday
All day sessions (6 + 2)
Trauma component
Excellent utilisation
EMERGENCY
No dedicated ortho
trauma session
Often delayed to after
hours
Cancellation of elective
cases
Orthopaedic trauma Session Utilisation
88
63.1
0 40 80 120 160
Ortho Trauma AllocatedHours
Ortho Trauma Utilisation (InOR - Out OR)
= 72%
0 200 400 600 800 1000 1200
Sunday 30-Sep-12Sunday 23-Sep-12Sunday 16-Sep-12Sunday 09-Sep-12Sunday 02-Sep-12
Saturday 29-Sep-12Saturday 22-Sep-12Saturday 15-Sep-12Saturday 08-Sep-12Saturday 01-Sep-12
Friday 28-Sep-12Friday 21-Sep-12Friday 14-Sep-12Friday 07-Sep-12
Thursday 27-Sep-12Thursday 20-Sep-12Thursday 13-Sep-12Thursday 06-Sep-12
Wednesday 26-Sep-12Wednesday 19-Sep-12Wednesday 12-Sep-12Wednesday 05-Sep-12
Tuesday 25-Sep-12Tuesday 18-Sep-12Tuesday 11-Sep-12Tuesday 04-Sep-12Monday 24-Sep-12Monday 17-Sep-12Monday 10-Sep-12Monday 03-Sep-12
Sum of OUT OF HRS mins(>1730 & w/e) Sum of IN HRS Mins
Jara Ward
Clinical Pathways
have seen the ALOS
for orthopaedic
patients reduced to
3.55 days. (0.81days
shorter than the
Australian Health
Roundtable average
of 4.36days)
Comparisons against Peer Hospitals
Rigel2 Top 10 Actual Savings Compared to All NSW Average
DRG
RIGEL2
All NSW Average
RSI Rank
Name ALOS ALOS
Other Hip & Femur Proc 7.3 12.1 1 of 15
Hip Replacement 6.4 9.0 2 of 19
D’mentia & Chrnic Disturb Crbrl Fn 4.8 11.4 2 of 15
Knee Replacment 5.3 6.7 3 of 17
Crc Dsrd Ami+Invas Invest Pr 3.4 1.3 1 of 13
Casearean Delivery 3.7 4.9 3 of 16
Mjr Small & Large Bowel Pr 10.1 12.2 3 of 20
Injsh, Arm, Elb, Kn, Leg, Ankle 3.2 3.4 5 of 21
Repiratory Neoplasms 5.5 7.0 1 of 16
Delirium 7.1 8.7 7 of 16
Rehabilitation
Therapy Intensity Initiative
– Physiotherapy
– Occupational therapy
90 minutes intensive
therapy per day
Reduced LOS
Improved quality of life
CSSD
Bottleneck
Refurbishment
New turbo washers
New sterilisers
RFID
Plans for the Future
Collaboration with Bariatric Surgery model
Extending follow-up
Skill sharing with other health care facilities
Expanding capacity
Acknowledgments
Cathy Brand – Physiotherapist OACCP
Dr Leonard Kalish – Dir Anaesthetics, SESLHD Clinical Council
Dr Robert Molnar – Orthopaedic Department
Vicki Morris – Clinical Resources Nurse, Theatres
Gabrielle Moses – CNC Pre-Admission Clinics
Barbara Passaris – NUM Rehab Ward
Juliette Proctor – NUM Jara Ward
Donna Riley – the best Data Manager in the universe
All photographs obtained with consent (and some coercion)