Abstract
Background
Patients with fractured neck of femur have historically received less attention than they deserve and have high morbidity and mortality. Literature suggests that speed to theatre reduces length of in-patient stay and complications.
Methodology
Using patients' expressed needs as a basis to redesign the service, a multidisciplinary project team mapped the current process of admission, simulated and mapped an ideal process. This resulted in a fast admission process for patients with suspected fractured proximal femur. Paramedics call a trauma coordinator based on the specialist ward who meets the patient at the door of the Emergency Department, escorting them to X-ray. The fracture is confirmed remotely by an experienced surgeon using PACS. Patients are taken to an optimisation area in the theatre complex for consultant orthopaedic and anaesthetic assessment prior to surgery the same day (utilising spare time on elective and trauma lists), or early the following day. Fascia-iliaca blocks are provided by trauma coordinators to improve pain control and reduce sedative effects of opiates, aiding early mobilisation. Measures include time to theatre, length of stay, and patient experience. Meaningful mortality and morbidity data will become available later.
Results
To date we have studied 79 patients (mean age 81 years) over ten weeks. Median time to theatre reduced from 42 hours to 22 hours (Range 2–78 hours). Median length of stay reduced from 10.5 days to 6 days (Range 2–20 days). Secondary improvements include list productivity, communication with relatives, patients' satisfaction. No increase in adverse events has been found and the anaesthetic team felt patients with chronic problems such as cardiac or renal failure were successfully operated on without unnecessary delays.
Future Developments
This new process is a permanent change; within six months we will have 250 cases to present, with results of additional metrics.
