ISQUA16-2603HALVING BROKEN HIPS IN HOSPITAL – THE NEW ZEALAND EXPERIENCE

Abstract

Objectives: The Health Quality & Safety Commission (the Commission), in partnership with the Accident Compensation Corporation and the Ministry of Health, is leading a national quality improvement programme to reduce harm from older people falling in care settings - hospital, aged residential care and receiving care at home. Method(s): National Serious Adverse event reporting identified in the early 2010 s that falls, and in particular falls associated with fractured neck of femur, were the most commonly reported adverse event in New Zealand hospitals. The Commission established a national Reducing Harm from Falls Programme in 2012 in response. Rather than a "bundle" of care practices, the programme has followed the philosophy of applying the right combination of interventions that address the specific risks of the individual, basing these on multiple robust, evidence-based interventions. The programme developed a suite of interactive and evidence-based resources, titled "the 10 Topics" to build capability of health professionals. A Falls Atlas of Healthcare Variation was also developed to show national and local data and to inform and guide local improvement. Reducing Harm from Falls is profiled every April under the banner of "April Falls" providing a reason for healthcare providers to refocus on the problem of and celebrate and share their successes in reducing harm. A "quality and safety marker" was established, linking measures of implementing process changes with outcomes, based on the Donabedian model. The process measure is the percentage of patients aged 75 and older given a falls risk assessment, and the percentage provided with an individualised care plan. The outcome measure is the number of hospital falls resulting in a fracture entering hospital aged 75+ who were assessed for the risk of falling increased from 76% at baseline (February 2013) to 92% in September 2015. Likewise, the proportion of patients assessed as at risk of falling who received an individualised care plan also increased from 80% (September 2013) to 92% in September 2015. A significant sustained reduction in hospital falls associated with a fractured neck of femur has been achieved from November 2014 onwards. Between the start of the programme and September 2015 there have been 37 fewer falls with a fractured neck of femur than would have been expected based upon the underlying rate between July 2010 and June 2012. This is a 35 per cent reduction (p =.003). Based on the New Zealand Institute of Economic Research (NZIER) 2010 estimate of $47,000 per hip fracture incident, this reduction conservatively represents a saving to the health system of $1.8 m. If 20 per cent of those incidents would have resulted in transfer to aged residential care, NZIER estimates would mean a saving of $2.4 m. Conclusion(s): A comprehensive, integrated quality improvement programme approach has resulted in a statistically significant reduction in in-patient falls with a fractured neck of femur in New Zealand public hospitals.