A Multidisciplinary Approach to Expedite Surgical Hip Fracture Care

Burton, Alex; Davis, Charles M.; Boateng, Henry A.; Fox, Edward J.; McQuillan, Patrick; Mets, Berend; Hassenbein, Susan E.; Black, Kevin P.; Munyon, Ryan; McGillen, Brian; Armstrong, April D.

doi:10.1177/2151459319898646

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…12 When we looked at our own trauma institution to determine how to improve outcomes, our findings shared similarities with other studies. Friedman et al, 20 Christiano et al, 16 and Burton et al 17 reported improved outcomes in geriatric patients with hip fracture after implementation of a protocol, which further highlights the importance of protocol-driven care. They showed that expedited surgical care improved time to surgery from 20.22 to 15.33 hours but did not show a difference in-hospital length of stay or mortality.…”

Section: Discussionmentioning

confidence: 98%

“… 16 Others have introduced a multidisciplinary approach that resulted in a 10% improvement in the percentage of patients having surgery within 24 hours. 17 …”

Section: Introductionmentioning

confidence: 99%

“…16 Others have introduced a multidisciplinary approach that resulted in a 10% improvement in the percentage of patients having surgery within 24 hours. 17 As a level-1 trauma center that routinely manages hip fracture patients, we have implemented our own unique collaborative hip fracture protocol (Figure 1), streamlining existing processes to expedite surgical intervention for isolated hip fracture patients. The protocol's purpose was to optimize the number of patients going to the operating room within 24 hours of their triage time and to maintain a hospital length of hospital stay of under 96 hours.…”

Section: Introductionmentioning

confidence: 99%

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Cracking the Hip: Does Protocol Matter? A Retrospective Cohort Study Investigating the Effect of Protocol Implementation

Levi

Coste

Warshowsky

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction Approximately 300 000 hip fractures occur annually in the USA in patients >65 years old. Early intervention is key in reducing morbidity and mortality. Our institution implemented a collaborative hip fracture protocol, streamlining existing processes to reduce time to OR (TTO) and hospital length of stay (LOS). Our aim was to determine if this protocol improved these outcomes. Study Design We conducted a retrospective cohort study using our level-1 trauma center’s trauma registry, comparing outcomes for patients >60 years old with isolated hip fractures pre-and post-hip protocol implementation in May 2018. Our primary outcomes were TTO and in-hospital mortality. Secondary outcomes included LOS and postoperative complications. Univariate analysis was done using chi-square and T-test. Results We identified 176 patients with isolated hip fractures: 69 post- and 107 pre-protocol. Comparing post- to pre-protocol, TTO decreased by 18hrs (39 vs 57h; P = .013) and patients had fewer postoperative complications (9 vs 23%; P = .016) despite post-protocol patients being more likely to have diabetes (42 vs 27%, P < .05), elevated BMI (22 vs 25; P < .001), and to be current smokers (9 vs 2%; P < .05). LOS and in-hospital mortality also decreased (11 vs 20d; P = .312, 4.3 vs 7.5%; P = .402). Post-protocol patients were more likely to go to the OR within 24hrs of presentation (39 vs 16%; P < .001) and to go straight from ED to OR (32 vs 4%; P < .001). Conclusion TTO, LOS, and postoperative complications for isolated hip fracture patients were lower post-protocol. Though not all statistically significant, this trend indicates that the protocol was helpful in improving hip fracture outcomes but may require further improvement and institution-wide education.

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Section: Discussionmentioning

confidence: 98%

“… 16 Others have introduced a multidisciplinary approach that resulted in a 10% improvement in the percentage of patients having surgery within 24 hours. 17 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cracking the Hip: Does Protocol Matter? A Retrospective Cohort Study Investigating the Effect of Protocol Implementation

Levi

Coste

Warshowsky

et al. 2022

Geriatr Orthop Surg Rehabil

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“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS 33,35,38,41,[43][44][45][46][47][48][49][51][52][53][54]56,57,[59][60][61][62][65][66][67][68][69][70][71][72][74][75][76][79][80][81][82][85][86][87][88]91,94,96,97,99,101,103 and 20 programs 39,40,42,50,…”

Section: Included Studiesmentioning

confidence: 99%

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

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“…There are numerous factors upsetting patient satisfaction: attainment attention from doctors, time taken to get schedule, opening hours, waiting time, expenses, expediency, treatment quality, pain management, and nurse communication [21]. The literature on patient satisfaction with primary care show that key attributes of healthcare treasured by patients are patient-centered, as well as time spent with the physician, willingness of the physician to listen to the patient, and expectations for treatment [9,22].…”

Section: Factors Upsetting Patient Satisfactionmentioning

confidence: 99%

Evaluating Patients’ Level of Satisfaction on the Quality of Health Services in Ekiti State University Teaching Hospital, Ado-Ekiti Nigeria

Bamise

Agbele

Adebayo

2021

AJMAH

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Aims: To evaluate patients’ level of satisfaction on the quality of healthcare received by focusing on waiting time due to its level of importance. Studies have shown that a good healthcare system contributes immensely to the growth of a thriving economy, because patients’ satisfaction is the major indicator of quality healthcare. Study Design: A descriptive cross-sectional study was employed by using a structured questionnaire coupled with interview session. These was considered appropriate for data gathering in the overall outpatient department (OPD) of the health facility. Methods: The present study evaluates patients’ satisfaction level on the QoS in Ekiti State University Teaching Hospital (EKSUTH), Nigeria; by focusing majorly on waiting time. Systematic random sampling technique was used in selecting the participants for this research, with 241 patients’ data collected. Convenience, courtesy and quality of care were used as factors to measure patients’ satisfactions. Results: Findings from this study showed that 73.03% of the patients were satisfied with the level of services in terms of conveniences, while 80.50% of the patients were highly satisfied as regards the courtesy level, also, 77.59% of the patients were satisfied with the quality of care received at the facility. Furthermore, our result indicates that a total of 154 (63.9%) of the patients were greatly satisfied with the quality of health services received in EKSUTH, however, 87 which represents 36.1% of patients were not satisfied with the level of services rendered at the facility. Conclusion: The respondents showed high satisfaction level in most of the services they received from EKSUTH, however, long waiting time in the health facility has shown to be an impediment to the satisfaction level as well as the quality of care (QoC) received. Therefore, improved services; especially reducing the long waiting time will motivate patients to continue to utilize EKSUTH. More so, continuous efforts should be made by the hospital’s administration to improve other areas where satisfaction level was shown to be low in the present study.

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A Multidisciplinary Approach to Expedite Surgical Hip Fracture Care

Cited by 7 publications

References 22 publications

Cracking the Hip: Does Protocol Matter? A Retrospective Cohort Study Investigating the Effect of Protocol Implementation

Cracking the Hip: Does Protocol Matter? A Retrospective Cohort Study Investigating the Effect of Protocol Implementation

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Evaluating Patients’ Level of Satisfaction on the Quality of Health Services in Ekiti State University Teaching Hospital, Ado-Ekiti Nigeria

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