Pre‐operative echocardiography for hip fractures: time to make it a standard of care

A reply

“…We continue with our policy of continuous improvement using 'performance by the aggregation of marginal gains' and we encourage others to join us in this quest. I read with interest the recent editorial by Wang et al [1] and found it greatly informative. However, I question the authors' equating of the state of unconsciousness with hypnosis and also draw attention to the use of medical hypnosis in uncovering episodes of intra-operative awareness.…”

“…The editorial by Heyburn and McBrien [1] suggests that echocardiography before hip fracture surgery should be routine. These conclusions, if applied, have to be extended to all emergency surgical procedures in the elderly.…”

“…We thank the correspondents for their constructive comments on our recent editorial [1] in which we sought to promote the inclusion of transthoracic echocardiography (TTE) for investigation of previously undiagnosed heart murmurs in the package of care provided to hip fracture patients without causing delay to surgery.…”

Rumsfeld revisited: knowns and unknowns affecting the right heart

“…Much has been debated upon the value of TTE in hip fracture patients. Recent publications lean towards the benefit of using the modality in this group of patients [17][18][19], but reticence remains within the anaesthetic community. One could claim that assessment of the right ventricle gives fortitude to the argument for using TTE and strengthens our resolve to find appropriate ways to enable us to do so, including considering training and accreditation in echocardiography [20].…”

Outcome by mode of anaesthesia for hip fracture surgery

“…This has been increasingly difficult to achieve and has not been made possible by any single intervention. Instead, we have achieved this using our mantra of 'performance by the aggregation of marginal gains' in our medical, surgical and anaesthetic management for hip fractures [3]. Each patient with hip fracture is evaluated, managed and treated as an individual case.…”