A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

Abstract

Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. The aim of this project was to identify evidence to practice gaps in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery.Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. ResultsEarly mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% -50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. ConclusionsThe chart review has identified a paucity of contextual information which may influence health care providers' behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour.Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider's ability to engage the patients in early mobility activities. Contributions To The LiteratureConducting a needs assessment through a chart review can provide insight to local contextual factors which influence clinical behaviours By following the French systematic method, specifically Step 1, we identify potential evidence-to-

Early Mobility After Fragility Hip Fracture: A Mixed Methods Embedded Case Study

“…The unit of study was selected as there is a history of recommendation implementation. A previous chart review of the unit [11] identi ed an absence of the contextual factors which are required to identify the barriers to localized knowledge sustainability and subsequent meaningful monitoring of knowledge use [33]. Consequently, this study has attempted to better understand the multi-level factors which may in uence both the provider facilitation and patient participation in early mobility activities.…”

“…There were a series of interprofessional staff education sessions, and patient education booklets to address meso and micro level factors. A recent chart review of the older adult hip fracture population on this unit [11] identi ed that early mobility activities are initiated in the rst ve days after surgery to varying degrees. Many patients did not participate in early mobility activities, with non-participation rates higher in those with a low pre-fracture functional mobility level and those with a cognitive impairment.…”

“…The hospital admits approximately 200 older adults with hip fracture per year [18]. As per Health Quality Ontario (HQO) recommendations [19], surgical repair of a fragility hip fracture occurs within 48 hours of patient admission [11]. The main case was purposefully selected as the unit where the majority of patients after hip fracture surgery are admitted.…”