Reduced delays in A&amp;E for elderly patients with hip fractures

Charalambous, Constadina; Yarwood, S; Paschalides, C; Siddique, Irfan; Paul, A; Hirst, P

doi:10.1308/003588403321661406

Cited by 14 publications

(10 citation statements)

References 7 publications

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“…Techniques to expedite preoperative care can shorten operative delays, especially for those patients that have been medically cleared for surgery. For example, a recent systematic review as well as a prospective study of 116 patients found that dedicated trauma coordinators or hospitalists have been shown to be effective at fast-tracking patients with hip fractures to surgery by organizing operating room lists, perioperative care, securing hospital beds, and acting as a liaison with the radiology department and porting services 2965. A retrospective analysis of 139 patients found that a dedicated trauma operating room not only reduced the time to dynamic hip screw and closed femoral nailing procedures, but also allowed more of these surgeries to be performed during daytime hours, which may reduce postoperative complications 66…”

Section: Methods For Minimizing Surgical Delaymentioning

confidence: 99%

Surgery for hip fractures: Does surgical delay affect outcomes?

Simunovic

Devereaux

Bhandari

2011

IJOO

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Hip fractures are associated with a high rate of mortality and profound temporary and sometimes permanent impairment of quality of life. Current guidelines indicate that surgeons should perform surgery for a hip fracture within 24 hours of injury because earlier surgery is associated with better functional outcome and lower rates of perioperative complications and mortality. Proponents of early treatment argue that this approach minimizes the length of time a patient is confined to bed rest, thereby reducing the risk for associated complications, such as pressure sores, deep vein thrombosis, and urinary tract infections. Those favoring delaying surgery beyond the guideline recommendations believe that this approach is required to medically optimize patients, and therefore decrease the risk for perioperative complications. Further challenges to resolving this debate is the lack of an accepted definition of what should constitute an “unacceptable delay” for hip fracture surgery and the fact that outcomes associated with surgical delay are based on observational data alone (i.e., not randomized controlled trials). The effect of preoperative timing on mortality and other patient-important outcomes across various age groups remains controversial and warrants a large randomized controlled trial to offer clear insights into the effects associated with early versus delayed surgery among hip fracture patients.

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Section: Methods For Minimizing Surgical Delaymentioning

confidence: 99%

Surgery for hip fractures: Does surgical delay affect outcomes?

Simunovic

Devereaux

Bhandari

2011

IJOO

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“…Studies have shown that treatment delays in the ED can be reduced with the use of ''fast-track'' programs. 16,17 However, to our knowledge, no one has performed a systematic analysis of the factors associated with wait times in the ED in the United States for patients with hip fracture. We performed a retrospective study evaluating patient, physician, and hospital factors that may affect time in the ED.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Emergency Department Length of Stay for Patients With Hip Fracture

Rashid

Brooks

Bessman

et al. 2013

Geriatr Orthop Surg Rehabil

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Time to surgery, which includes time in the emergency department (ED), is important for all patients with hip fracture. We hypothesized that patients with hip fracture spend significantly more time in the ED than do patients with the top 5 most common conditions. In addition, we hypothesized that there are patient, physician, and hospital factors that affect the length of time spent in the ED. We retrospectively reviewed our institution's hip fracture database and identified 147 elderly patients with hip fractures who presented to our ED from December 18, 2005, through April 30, 2009. We reviewed their records for patient, practitioner, and hospital factors of interest associated with ED time and for 6 specified time intervals. Average working, boarding (waiting for an inpatient room), and total times were calculated and compared with respective averages for admitted ED patients with the top 5 most common conditions. Univariate and multivariate analyses were performed before and after adjusting for confounders (significance, P ¼ .05). The mean total ED time (7 hours and 25 minutes) and working time (4 hours and 31 minutes) for patients with hip fracture were similar to the respective overall averages for admitted ED patients. However, the average boarding time for patients with hip fracture was 2 hours 44 minutes, longer than that for other patients admitted through the ED. Factors significantly associated with longer ED times were a history of hypertension, history of atrial fibrillation, the number of computed tomography scans ordered, and the occupancy rate. Admission to the hip fracture service decreased working time but not overall time. Substantial multidisciplinary work among the ED, hospital admission services, and physicians is needed to dramatically decrease the boarding time and thus the overall time to surgery.

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“…A group of 50 patients with hip fractures admitted to a hospital via the ED in Manchester were studied prior to the introduction of a fast-track hip fracture protocol. The median ED-to-ward transfer time was reduced following its introduction by 43%, from 7 hours 4 minutes (range 2 hours 46 minutes to 11 hours 50 minutes) to 4 hours (range 1 hour 8 minutes to 11 hours 58 minutes, P < 0.0001) [70]. A major limitation of these studies of hip fracture-specific fast-track systems is that none studied their effect on waiting times for other patients in the ED.…”

Section: Question 4: In Hospital Eds Experiencing Overcrowding (Settimentioning

confidence: 97%

Emergency Department Overcrowding

Schull

Cooke

2008

Evidence‐Based Emergency Medicine

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Reduced delays in A&E for elderly patients with hip fractures

Cited by 14 publications

References 7 publications

Surgery for hip fractures: Does surgical delay affect outcomes?

Surgery for hip fractures: Does surgical delay affect outcomes?

Factors Associated With Emergency Department Length of Stay for Patients With Hip Fracture

Emergency Department Overcrowding

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