Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic

Ali, Mohammed; Fadulelmola, Ahmed; Urwin, Marie; Niţă, Cristian

doi:10.22540/jfsf-07-013

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Notably, this sum excludes the potential costs arising from possible prolonged in-patient stay and costs arising from hospitals needing extra instrument kits for possible remedial action. This financial cost is equivalent to the best practice top-up tariff for treating approximately 108 hip fracture patients based on £1,335 per patient [17]. This highlights an area of potential cost savings.…”

Section: Discussionmentioning

confidence: 98%

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists

Anazor¹,

Sibanda²,

Altaf³

et al. 2022

Cureus

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IntroductionSurgical site infections (SSIs) are a universally dreaded complication of any surgical procedure. The goal of this single-center study was to examine the issue of orthopaedic instrument wrapping defects with a focus on the importance of a high level of surveillance to enable identification of these defects in order to reduce the risk of instrument contamination. We also evaluated the impact on patient care, theatre staff, hospital finances and resource utilization during a defined study period in order to stimulate critical discussion and further research into potentially eliminating this problem via change in practice and advances in technology. To the best of our knowledge, this will be the first paper that looks at this problem from the above perspective within the United Kingdom National Health Service. MethodsWe conducted a prospective service evaluation project over a 30-week period from December 2021 to July 2022 across our three hospital sites within the United Kingdom National Health Service. We collated data on defects found in orthopaedic instrument wrappings as detected by visual inspection under ambient or theater lighting and the resulting surgical case cancellations. Defect types included in the study were all puncture holes, abrasions or tears visible to the naked eye irrespective of their size. ResultsA total of 601 orthopaedic sets were rejected during the study period due to defects identified in the sterile instrument wrappings. Of these, 437 were due to holes/tears in the wrapping, 129 were due to wet inner wrappings and 35 were due to insecure wrappings. This directly resulted in same-day cancellation of 13 surgical cases or 0.27% of booked cases with extra sets required for the other affected cases. These 13 cases could not proceed as they involved loan kits where no remedial action could be taken. Remedial action was required for the other 588 operation list cases affected by the sterile wrapping defects. The majority of the identified defects and resulting theatre case cancellations (61.5%) were in hip and knee arthroplasty surgery. The calculated potential financial loss due to these problems was £145,000 over the seven-month study period. This financial cost is equivalent to the best practice top-up tariff in England for treating approximately 108 hip fracture patients based on £1,335 per patient. ConclusionOur study identified defects in the sterile instrument wrappings affecting both the inner with or without involving the outer wrapping layer and resulting in cancellation of elective and trauma orthopaedic cases with resultant clinical and financial implications. There is a need to be more vigilant in identifying defects in drapes. Further research is warranted to improve ways of identifying defects in sterile wrappings and devise new protective mechanisms during sterilisation that can eliminate the use of sterile instrument wrappings.

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Section: Discussionmentioning

confidence: 98%

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists

Anazor¹,

Sibanda²,

Altaf³

et al. 2022

Cureus

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“…Neck of the femur (NOF) fracture in the geriatric population is one of the most frequent presentations in hospitals in the United Kingdom (UK) [ 1 ]. The estimated number of admissions is about 80,000 annually, and the annual cost implications are nearly two billion pounds.…”

Section: Introductionmentioning

confidence: 99%

“…The estimated number of admissions is about 80,000 annually, and the annual cost implications are nearly two billion pounds. It is one of the commonest causes of fracture-related death in the United Kingdom, and the incidence is expected to reach a hundred thousand by 2030 [ 1 ]. Intertrochanteric neck of the femur (NOF) fractures are prevalent, and the majority are fixed using a dynamic hip screw (DHS) or, occasionally, an intramedullary (IM) nail with a fixed angle.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

Ali¹,

Al‐Dadah²

2023

Cureus

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BackgroundIntertrochanteric neck of the femur (NOF) fractures are very common, and the majority are fixed using dynamic hip screws (DHS) or intramedullary (IM) nails with a fixed angle. The aim of this study was to assess which angle of fixation has a better tip-apex distance (TAD) on X-ray and lower complication rates. MethodsWe included patients with intertrochanteric hip fractures fixed using a DHS or an IM nail. We included patients who had complete radiological and clinical records and a minimum follow-up of 24 months. We measured the TAD and recorded the number of implant cutouts, fracture site nonunions, and periprosthetic fractures. ResultsA total of 107 patients were included, 35 IM nails and 72 DHS. There were four cases of implant cutouts within the DHS group and none in the IM nail group. All four cutout cases were fixed using 135° angle DHS, and two had TAD of more than 25 mm. Multivariable regression analysis revealed that the implant fixation device (p=0.002) and the angle of fixation (p<0.001) are the most important predictors of TAD. ConclusionSmaller angle (130° or 125°) fixation devices allow better positioning of the lag screw and consequently better TAD, which leads to a lower probability of implant cutout in patients undergoing fracture of the neck of the femur surgery.

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The Impact of COVID-19 on the Prevalence, Mortality, and Associated Risk Factors for Mortality in Patients with Hip Fractures: A Meta-Analysis

Ding

Wei

Wang

2023

Journal of the American Medical Directors Association

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Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic

Cited by 5 publications

References 18 publications

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

The Impact of COVID-19 on the Prevalence, Mortality, and Associated Risk Factors for Mortality in Patients with Hip Fractures: A Meta-Analysis

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