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)