Published: 28/07/2005, Volume II5, No. 5966 Page 20

Trusts are under pressure to reduce length of stay while maintaining quality of care - and this will only increase under payment by results. But this should not lead to increased readmission. Analysis of length of stay for orthopaedic conditions for 2004 showed that United Lincolnshire Hospitals trust was better than the national average.

However, readmission rates for fractured neck of femur were high and compared poorly to other trusts.

Further analysis showed that the readmission rate for fractured neck of femur was significantly worse at one of the trust sites. The clinical director led a review that found several causes for this, and the clinical team focused on two specific areas.

The first was around improvements in co-ordination and planning of care:

l Development of a trauma stabilisation unit to take direct referrals from GPs and stabilise patients before theatre.

l Appointment of a second trauma co-ordinator to work with the orthopaedic team and link to other specialties, such as elderly care.

l Review of the care pathway.

l Twice-weekly elderly care physician ward rounds.

The second area was action to improve discharge:

l Implementation of software to allow staff to monitor patients' expected date of discharge, identify issues causing delay and take action to maintain the planned discharge date.

l Appointment of a trauma patient care coordinator to ensure that discharge planning starts before admission and results in a clinically safe discharge with patient follow-up at home.

l Teaching patients to self-administer injections to prevent deep-vein thrombosis and pulmonary embolism after discharge.

The most recent analysis of readmissions across the trust shows that the trend is now below the England average. At the site previously highlighted, the risk of readmission from fractured neck of femur has fallen well below the average (from an index level of 225 in the third quarter of 2003 to 50.3 in December 2004). The changes have not adversely affected the length of stay, which also remains better than average.

The trust is now in an ongoing programme comparing length of stay and readmission rates for all orthopaedic conditions to highlight good performance and indicate where action is required. .

Dr Marc Farr is product development manager at Dr Foster (phone 020-7330 0472 or visit www. drfoster. co. uk). The next Dr Foster page is on 11 August and will cover cancer waiting times.