Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries

Crespi, Zachary; Hasan, Ahmad I; Pearl, Adam; Ismail, Aya; Awad, Mohamed E.; Irfan, Furqan B.; Jaffar, Muhammed; Patel, Padmavathi; Saleh, Khaled J.

doi:10.2106/jbjs.rvw.21.00152

Cited by 2 publications

(3 citation statements)

References 88 publications

(108 reference statements)

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“…The maximum number of clinical indicators possible in our dataset was 13, and data for three of the indicators (#10, 12, and 14) were not obtainable. Secondly, health service data such as ED/hospital LOS, operative procedures performed, and nationally defined hospital-acquired complications [8] were obtained from the ISLHD performance unit. Finally, we collected acute and sub-acute (rehabilitation) LOS and treatment costs.…”

Section: Methodsmentioning

confidence: 99%

“…We note updated standards and indicators will be released in late 2023. To aid in delivery of care to meet these standards, 86% of Australian hospitals have a hip fracture protocol [4], and most centres report that standards have resulted in improved care [8]. However, uptake of hip fracture protocols is inconsistent [9] and hospital-dependent.…”

Section: Introductionmentioning

confidence: 99%

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Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Curtis,

McKenzie,

Melville

et al. 2024

Gerontology

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Introduction: Hip fracture in older adults results in significant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group; however, uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes. Methods: This controlled pre- and post-test study was conducted from June 2019–June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs. Results: There were 565 cases included for analysis. After implementation of eHIP (the post-period), 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presentation (pain and cognitive assessment) increased by 23%, and unrestricted mobilisation within 24 h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2–57%), and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change. Discussion/Conclusion: eHIP, a hip fracture care program incorporating evidence-based behaviour change theory, resulted in sustained improvements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Curtis,

McKenzie,

Melville

et al. 2024

Gerontology

View full text Add to dashboard Cite

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“…Previous studies regarding in-hospital patient falls have been based on hospital-wide falls, involving all patients from different departments, from internal medicine to the surgery department [11][12][13][14][15] . Risk factors, such as older age, use of sedative medications, history of delirium, and previous falls, have been identified for in-hospital falls 4,11,15,16 .…”

mentioning

confidence: 99%

Risk Factors and Characteristics of In-Hospital Falls After Spine Surgery

Shin,

Park,

Park

et al. 2024

JBJS Open Access

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Background: Falls after orthopaedic surgery can cause serious injuries, which lengthen hospital stays and increase medical expenses. This has prompted hospitals to implement various fall-prevention protocols. The aims of this study were to determine the incidence of in-hospital falls after spine surgery, to analyze the overall risk factors, to discern factors that have a major influence on falls, and to evaluate the effectiveness of the fall-prevention protocol that we implemented. Methods: This was a retrospective, single-center study including patients who underwent spine surgery from January 2011 to November 2021 at the National Health Insurance Service Ilsan Hospital (NHISIH) in Goyang, Republic of Korea. Reported falls among these patients were examined. Patient demographics; surgery type, date, and diagnosis; and fall date and time were evaluated. Results: Overall, 5,317 spine surgeries were performed, and 128 in-hospital falls were reported (overall incidence: 2.31%). From the multivariable analyses, older age and American Society of Anesthesiologists (ASA) score were identified as independent risk factors for in-hospital patient falls (multivariable adjusted hazard ratio [aHR] for age 70 to 79 years, 1.021 [95% confidence interval (CI), 1.01 to 1.031]; for age ≥80 years, 1.035 [1.01 to 1.06]; and for ASA score of 3, 1.02 [1.01 to 1.031]). Similar results were seen in the subgroup who underwent primary surgery. Within 2 weeks following surgery, the highest frequency of falls occurred at 3 to 7 days postoperatively. The lowest fall rate was observed in the evening (6 to 10 p.m.). Morbidities, including rib, spine, and extremity fractures, were recorded for 14 patients, but none of these patients underwent operative treatment related to the fall. The NHISIH implemented a comprehensive nursing care service in May 2015 and a fall protocol in May 2017, but the annual incidence rate did not improve. The fall rate was higher after thoracolumbar surgeries (2.47%) than after cervical surgeries (1.20%). Moreover, a higher fall rate was observed in thoracolumbar cases with a greater number of fusion levels and revision spine surgeries. Conclusions: Patients with advanced age, more comorbidities, a greater number of fusion levels, and revision surgeries and who are female are more vulnerable to in-hospital falls after spine surgery. Novel strategies that target these risk factors are warranted. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries

Cited by 2 publications

References 88 publications

Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Risk Factors and Characteristics of In-Hospital Falls After Spine Surgery

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