HSJ Awards 2015: Patient safety

West Hertfordshire Hospitals Trust – The hip fracture journey through the lives of Alice and Dorothy

With a hip fracture mortality rate of 12 per cent in 2012-13, West Hertfordshire Hospitals Trust set out to redesign the pathway.

Alice was 84, sustained a hip fracture, and was admitted to hospital distressed, frightened and challenging to manage. 

Alice was given pain relief, transferred to a general ward and made it to evening theatre 15 hours after being admitted. She received general anaesthetic and later, on the surgical ward, antipsychotic drugs. No-one called or visited. During the night, she deteriorated and died. 

Dorothy came in after the service redesign. The 95-year-old also sustained a hip fracture and came in distressed, frightened, and restless. 

Dorothy was seen quickly in A&E by senior specialists and transferred to the neck of femur ward. The specialist nurse ensured care was coordinated and tailored. Alongside comforting words, a junior doctor administered fascia block pain-relief. Dorothy was fast-tracked to theatre and given spinal anaesthesia. Recovery was uneventful. 

The changes to a people-centred philosophy saw mortality dramatically reduce to 5.4 per cent in 2014-15. Average length of stay has been cut by more than two days, saving about £400,000 per year.

Judges hailed the “value driven” and “patient centred” approach and said West Hertfordshire Hospitals Trust was a clear winner in this category.