Improving the preoperative care of patients with femoral neck fractures through the development and implementation of a checklist

Abstract

The incidence of femoral neck fractures (FNFs) is expected to rise with life expectancy. It is important to improve the safety of these patients whilst under the care of orthopaedic teams.This study aimed to increase the performance of vital preoperative tasks in patients admitted for femoral neck fracture operations by producing and implementing a checklist as an aide memoir. The checklist was designed primarily for use by senior house officers (SHOs) admitting patients from the emergency department.A list of 12 preoperative tasks was identified. A baseline audit of 10 random patients showed that the mean proportion of the 12 tasks completed was 53% (range 25% - 83%). A survey of 14 nurses and surgeons found that the majority of respondents agreed that there was a problem with the performance of most of the tasks. The tasks were incorporated into a checklist which was refined in three plan-do-study-act cycles and introduced into the femoral neck fracture pathway.In the week following the introduction of the checklist, 77% of the checklist tasks were completed, 24% more than at the baseline audit (53%). In week 3, the completion of checklist tasks rose to 88% and to 95% in week 4.In conclusion, a simple checklist can markedly improve the performance and recording of preoperative tasks by SHOs. We recommend the wider adoption of the new checklist to be produced as a sticker for patients’ medical records. Further study is required to ascertain the effect of the checklist on clinical outcomes.

Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry

“…The modifiable risk factors found in our investigation are possible approaches for implementation of prevention strategies and patient optimization in the preoperative setting when THA for FNF is necessary. Introduction of a standardized pre- and perioperative protocol with elements of known pre-habilitation measures, such as the use of preoperative wash kits, adjustment of a regular blood glucose level, and strict peri- and postoperative surveillance, can help improve the mortality and failure rate after FNF [ 3 , 35 , 36 ]. However, some elements of pre-habilitation, such as regular physiotherapy before hip arthroplasty to improve strength and mobility, are not feasible in fracture patients [ 36 ].…”

Implementing PERFECT-ER with Plan-Do-Study-Act on acute orthopaedic hospital wards: Building knowledge from an implementation study using Normalization Process Theory

“…The intervention is: the PERFECT-ER checklist (henceforth checklist) which synthesises best practice for hospital-based dementia care with current best practice for hip fracture care, change agents (SIL and PPL) and a model for change (PDSA). Checklists have previously been used in acute care to improve practice [28], however this is not currently in the public domain but described more fully elsewhere [29].…”

Improving inpatient care with the introduction of a hip fracture pathway

“…Checklists of essential pre-operative tasks were added, which have been demonstrated to improve the rate of completion of required jobs. [17] Additionally, the NHFS calculator was included, with prompts to book post-operative HDU beds at admission for those with a predicted 30-day mortality > 5%.…”