20 NHS trusts across England have improved the quality of their hip fracture and primary hip/knee joint replacement surgery after implementing the NHS Institute for Innovation and Improvement's Rapid Improvement Programme for orthopaedics during 2009.

Every year the NHS in England treats over 70,000 patients with fractured neck of femur and approximately 120,000 patients undergo a hip or knee replacement. Together, the conditions account for £100 billion of the NHS England budget and these numbers are rising because of the aging population.

The ideal pathways for both types of patient were outlined in two NHS Institute reports published in 2006: Focus on: Fractured Neck of Femur and Focus on: Primary Hip and Knee Replacement. The aim of the Rapid Improvement Programme was to work with two trusts in each strategic health authority region to help them adopt these characteristics. A range of implementation tools were developed and tested by frontline staff before being standardised, packaged and used across the 20 hospitals taking part.

Sandra Corry, Lead Associate from the NHS Institute said: "Results from the trusts who took part in the programme show NHS organisations everywhere that fantastic quality improvements and efficiency savings can be made within just 12 weeks."

"If all trusts in England implemented these tools there would be a significant national impact. Imagine if the average length of stay achieved at the top performing trusts became the national standard: not only would thousands of patients get back to their homes more quickly, we'd also release savings of £75 million for fractured neck of femur and £63 million for hip and knee replacements."

Two Consultant Orthopaedic Surgeons (Phil Roberts of the University Hospital of North Staffordshire and Rob Middleton of Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) and a physician (Dr Elizabeth Aitken, Consultant Physician in Elderly Medicine at the University Hospital Lewisham) were seconded to the NHS Institute as clinical leads for the programme to ensure that the programme was developed with the realities of the NHS frontline in mind.

Dr Elizabeth Aitken said: "The involvement of an orthogeriatrician (a care of the elderly physician with an interest in fracture care) has been key to the success of this programme. Many elderly fracture patients are frail and have complex medical problems. Their need for specialist medical care and early rehabilitation is best addressed when an orthogeriatrician is fully integrated in the work of the fracture service. This has many advantages including overall improvement in standards of medical care."

Lorraine Lambert, Chief Executive at South Tyneside NHS Foundation Trust said: "We found working with the NHS Institute on this project helped us make a huge impact on our service for primary hip and knee replacement. We've managed to eliminate cancelled operations and reduce the average length of stay for patients from 8 days to 6 (hips) and 11.5 days to 7 (knees). We've also ensured that 100% of our patients now get a pre-operative assessment before they are admitted and increased the number of patients who have their operation on the day they are admitted from 12% to 97%."

Jolyon Lockhart, Senior Clinical Nurse Trauma/Education at Poole Hospital NHS Foundation Trust said: "The programme has allowed us to make huge improvements to our fractured neck of femur pathway. We now provide all patients with an expected date of discharge before they have their operation. At the end of the programme, we had re-organised our daily trauma list to offer surgery to 80 - 90% of well patients within 48 hours, and 40% within 24 hours. We are also taking care to ensure that when there are no complications, we get the patient up and out of bed mobilising within 18 hours."

A national event was held today to celebrate the success of the Rapid Improvement Programme in orthopaedics at the National Motorcycle Museum in Birmingham. Attended by NHS managers and healthcare professionals from across England, the event was designed to share learning and showcase results and findings from the 20 NHS trusts on the programme.

Source
NHS