FRACTURED NECK OF FEMUR DELAY TO SURGERY – AN EFFECTIVE USE OF AUDIT.

Abstract

Parker et al examined the effect that delay to surgery has on patients with proximal femoral fractures. They found that a delay of more than 48 hours to surgery significantly increased the patient’s length of stay. They examined delays due to lack of theatre resource only.

Therefore an audit was proposed at the RUH Bath to set a standard of care that fracture neck of femur patients should be operated on within 48 hours. One month of data was collected (August 2005) and analysed. Of 52 fracture neck of femur patients 23% were waiting longer than 48 hours. The recommendation was made to have extra lists made available for fracture neck of femur patients.

In January 2006 the elective orthopaedic ward was closed (for 12 days) due to diarrhoea and vomiting. Therefore elective lists were utilised for trauma. The audit was repeated comparing these 12 days with 12 in December. In the December cohort seven neck of femur fracture patients waited more than 48 hours, in the January cohort no neck of femur patient waited more than 48 hours. A further recommendation was made for increased theatre capacity for neck of femur patients.

Subsequent to these recommendations 2 half day fracture neck of femur lists have been added to the rota at the RUH Bath. (Tuesday and Thursday pm). The patients can be assessed and worked up as planned trauma and can be seen in advance by the anaesthetist. Audit of January 2007 fractured neck of femur patients showed that there were 46 patients treated with only 1 waiting more than 48 hours due to theatre capacity.

In conclusion the audit process can work and achieve beneficial results as shown here. An accepted standard of care was taken from the literature, department performance analysed, changes implemented and closure of the audit loop has shown that it has worked.