Abstract
Introduction
Delay, postponing and cancellation of hip fracture surgery leads to unnecessary starvation and adverse effects on patients and resources. Best Practice Tariffs (BPT) have been introduced to incentivise organisation into optimising the overall care for this type of injuries.
Methods
Retrospective observational analysis of all consecutive cases of hip fractures over a period of 18 months; this period spanned the introduction of BPT: 10 months before and 8 months after. Data on delay, postponing and cancellation of surgery were recorded and analysed.
Results
Total of 584 cases with a surgery cancellation rate of 21% (n=121). Top three reasons for cancellation: 48% medically unfit, 32 % lack of operating time, 6% patient unprepared. Rate of surgery cancellation pre-BPT 26% (n=85), post-BPT 14% (n=36). Top three reasons for cancellation pre vs. post BPT were respectively: medically unfit 48% vs. 47%, lack of operating time 32% vs. 33%, patient unprepared 6% vs. 8%. Mean time from admission to surgery was in pre-BPT: 43.03 hours, in post-BPT: 34.33 hours. Surgery occurred at ≥36 hours after admission in 43.3% (first group), in 25% (second group). Lack of operating theatre time as reason for delay in surgery dropped from 37% to 20%. In contrast, the rate of theatre list overrun increased from 7% to 16%.
Conclusions
According to our district general hospital experience; the implementation of national guidelines and financial incentives helped reduce time delay and rate of cancellation of hip fracture surgery. These changes were achieved despite access to the same level of resources.
