The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

Barr, Lynne; Vindlacheruvu, Madhavi; Gooding, Chris

doi:10.1016/j.injury.2014.12.005

Cited by 13 publications

(13 citation statements)

References 16 publications

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“…For example, 2 European studies attributed surgical delay for hip fracture patients in new L1TCs to the burden imposed by higher priority trauma patients. 13,14 Previous studies have shown that delays in surgically treating hip fractures are associated with increased rates of VTE. 21,22 The patients treated at L1TCs in our cohort underwent surgery later and had higher odds of VTE.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence from Europe that older adults with hip fractures receive worse quality care and have higher odds of mortality in TCs. 13,14 In the United States, an observational study using NSQIP data reported that emergency general surgical patients have greater overall 30-day morbidity when treated at TCs compared with nontrauma centers (NTCs). 15 These findings could reflect inadequate risk adjustment and selection bias of complex patients to large regional centers.…”

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confidence: 99%

“…However, TC designation increases hospital workload [16][17][18] and some patient groups may compete ineffectively for resources (eg, operating room time) with more urgent cases in TCs. 13,14 There is consistent evidence that older adults with hip fractures benefit from prompt surgical treatment to reduce pain, expedite mobility, and minimize the risk of complications. 19 The adverse sequelae of prolonged immobility following hip fracture include lower respiratory tract infections, decubitus ulcers, 20 and venous thromboembolism (VTE).…”

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confidence: 99%

See 2 more Smart Citations

Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Metcalfe

Olufajo²,

Zogg³

et al. 2016

Medical Care

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Metcalfe

Olufajo²,

Zogg³

et al. 2016

Medical Care

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“…16 Similarly, in the United Kingdom, operations for patients with a fracture of the hip were delayed in one hospital when it became an MTC, with an associated increase in post-operative medical complications. 15 In contrast, a recent study from the United States reported that the outcomes following fracture of the hip were comparable between higher-and lower-level trauma centres. 17 However, trauma systems were established in the United States as early as 1987 and so this finding might not be applicable to the United Kingdom, where trauma care was only recently regionalised.…”

Section: 00mentioning

confidence: 93%

“…theatre time, with more urgent cases, such as open fractures and multiply-injured patients. 15,16 In The Netherlands, a number of outcomes including time to operation, length of stay, complications, re-intervention, and mortality were found to be worse at a level one trauma centre than at another hospital nearby. 16 Similarly, in the United Kingdom, operations for patients with a fracture of the hip were delayed in one hospital when it became an MTC, with an associated increase in post-operative medical complications.…”

Section: 00mentioning

confidence: 99%

Quality of care for patients with a fracture of the hip in major trauma centres

Metcalfe

Gabbe

Perry

et al. 2016

The Bone & Joint Journal

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Contextual Determinants of Time to Surgery for Patients With Hip Fracture

Welch,

Gomez,

Chatterjee

et al. 2023

JAMA Netw Open

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ImportanceSurgery within 24 hours after a hip fracture improves patient morbidity and mortality, which has led some hospitals to launch quality improvement programs (eg, targeted resource management, documented protocols) to address delays. However, these programs have had mixed results in terms of decreased time to surgery (TTS), identifying an opportunity to improve the effectiveness of interventions.ObjectiveTo identify the contextual determinants (site-specific barriers and facilitators) of TTS for patients with hip fracture across diverse hospitals.Design, Setting, and ParticipantsThis qualitative mixed-methods study used an exploratory sequential design that comprised 2 phases. In phase 1, qualitative semistructured interviews were conducted with stakeholders involved in hip fracture care (orthopedic surgeons or residents, emergency medicine physicians, hospitalists, anesthesiologists, nurses, and clinical or support staff) at 4 hospitals with differing financial, operational, and educational structures. Interviews were completed between May and July 2021. In phase 2, a quantitative survey assessing contextual determinants of TTS within 24 hours for adult patients with hip fracture was completed by orthopedic surgeon leaders representing 23 diverse hospitals across the US between May and July 2022. Data analysis was performed in August 2022.Main Outcomes and MeasuresThematic analysis of the interviews identified themes of contextual determinants of TTS within 24 hours for patients with hip fracture. The emergent contextual determinants were then measured across multiple hospitals, and frequency and distribution were used to assess associations between determinants and various hospital characteristics (eg, setting, number of beds).ResultsA total of 34 stakeholders were interviewed in phase 1, and 23 surveys were completed in phase 2. More than half of respondents in both phases were men (19 [56%] and 18 [78%], respectively). The following 4 themes of contextual determinants of TTS within 24 hours were identified: availability, care coordination, improvement climate, and incentive structure. Within these themes, the most commonly identified determinants across the various hospitals involved operating room availability, a formal comanagement system between orthopedics and medicine or geriatrics, the presence of a physician champion focused on timely surgery, and a program that facilitates improvement work.Conclusions and RelevanceIn this study, contextual determinants of TTS within 24 hours for patients with hip fracture varied across hospital sites and could not be generalized across various hospital contexts because no 2 sites had identical profiles. As such, these findings suggest that guidance on strategies for improving TTS should be based on the contextual determinants unique to each hospital.

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The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

Cited by 13 publications

References 16 publications

Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Quality of care for patients with a fracture of the hip in major trauma centres

Contextual Determinants of Time to Surgery for Patients With Hip Fracture

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