Does achieving the ‘Best Practice Tariff’ criteria for fractured neck of femur patients improve one year outcomes?

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1358-1363 ◽  
Author(s):  
Samuel R. Whitaker ◽  
Sohail Nisar ◽  
Andrew J. Scally ◽  
Graham S. Radcliffe
Keyword(s):  
Best Practice ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
One Year

22 Design and Implementation of A Nutrition Clinical Pathway for Patients with Fractured Neck of Femur

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Kingdon ◽  
H Aadan ◽  
S Husain ◽  
C Atkinson ◽  
C Thomson ◽  
...  
Keyword(s):  
Clinical Pathway ◽  
Best Practice ◽  
Nutritional Assessment ◽  
Nutritional Supplements ◽  
Alternative Methods ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Post Surgery ◽  
Retrospective Audit ◽  
Pdsa Cycle

Abstract Background Patients with a fractured neck of femur (FNOF) are commonly malnourished pre-admission, have reduced oral intake in hospital and a hypermetabolic state up to three months postoperatively (E Paillaud 2000). Malnutrition is associated with functional deterioration, higher morbidity and mortality. Evidence suggests nutritional supplementation post-surgery can reduce postoperative complications. As a result, nutritional assessment is included in the National Hip Fracture Database best practice tariff (Avenell, Cochrane Database of Systematic Reviews 2016). Introduction Our aim was to design and implement a clinical pathway for patients with FNOF to identify malnutrition and provide appropriate nutritional support. Intervention A retrospective audit of 25 patients was completed to understand baseline rates of assessment, prescription of supplements and referral to dietetics. Using these data meetings were arranged to develop a clinical pathway. Key stakeholders included dietetics, orthopaedic surgeons, geriatricians, physiotherapists and nurses. The pathway was evaluated and optimised with two Plan-Do-Study-Act (PDSA) cycles looking at 25 patients each time. Results Baseline: 79% received a nutritional assessment, 32% had nutritional supplements prescribed and 36% (n=9) met criteria for referral to a dietician, of which 55%were referred. However, an additional 5 referrals were made to dietetics for patients who did not meet criteria, a 50% inappropriate referral rate. PDSA cycle 1: increased nutritional assessment (85%), increased nutritional supplements prescribed (92%), decreased inappropriate referrals to dietetics (43%). PDSA cycle 2: increased nutritional assessment & nutritional supplements prescribed (100%), increased inappropriate referrals to dietetics (80%). Conclusions The implementation of a nutrition pathway has led to increased identification and treatment of malnutrition, which has in addition improved accrual of the best practice tariff. However, greater number of inappropriate referrals have been made to dietetics. This is partly attributed to difficulty weighing patients on admission, and where no weight is inputted on the Malnutrition Universal Screening Tool a “High Risk” score is generated triggering a referral. We are now looking at alternative methods to obtaining a weight such a mid-upper arm circumference.

scholarly journals The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

2019 ◽  
Vol 101 (5) ◽  
pp. 342-345
Author(s):  
J Craik ◽  
R Geleit ◽  
J Hiddema ◽  
E Bray ◽  
R Hampton ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Best Practice ◽  
Complication Rates ◽  
Delayed Presentation ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

scholarly journals Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

2013 ◽  
Vol 95 (1) ◽  
pp. 26-28 ◽  
Author(s):  
WKM Kieffer ◽  
CS Rennie ◽  
AJ Gandhe
Keyword(s):  
Serum Albumin ◽  
Statistical Significance ◽  
Postoperative Mortality ◽  
Decision Making Process ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Operative Planning ◽  
Implant Selection ◽  
One Year ◽  
Preoperative Albumin

A simple measure to determine one-year mortality following hip fractures has its benefits. Where there is controversy over implant selection, such a scoring system can facilitate the decision-making process. We undertook a retrospective analysis of one-year postoperative mortality of our hip fracture patients and established their admission serum albumin levels to see if there was any correlation between this and one-year mortality. Our results showed one-year mortality was significantly higher (p=0.0049) for those patients with a serum albumin of <35g/dl. Of the patients with low albumin, we found that there was no statistical significance between one-year mortality and source of admission (p=0.0789). Prefracture serum albumin can be used as a simple predictor of one-year mortality in patients presenting with a fractured neck of femur, thereby aiding operative planning and implant selection with a view to likely survival and possible need for revision.

scholarly journals Adherence to guidelines regarding total hip replacement for fractured neck of femur

2016 ◽  
Vol 98 (6) ◽  
pp. 422-424 ◽  
Author(s):  
A Fishlock ◽  
C Scarsbrook ◽  
R Marsh
Keyword(s):  
Hip Fracture ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Best Practice ◽  
Treatment Strategies ◽  
National Average ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
American Society

Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 – December 2013) were collected retrospectively from Scarborough Hospital’s hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.

scholarly journals 127 Fascia iliaca block in the emergency department-a quality improvement project, queen elizabeth hospital Birmingham

2020 ◽  
Vol 37 (12) ◽  
pp. 844-845
Author(s):  
Catherine Browne ◽  
Riad Hosein ◽  
Alistair Jellinek
Keyword(s):  
Local Anaesthetic ◽  
Best Practice ◽  
Queen Elizabeth Hospital ◽  
List Type ◽  
Post Intervention ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Post Procedure ◽  
Fascia Iliaca Block

Aims/Objectives/BackgroundFractured neck of femur is a common presentation and is associated with high rates of morbidity and mortality. RCEM Best Practice specifies that Fascia Iliaca Block should be available in Emergency Departments as part of the pain management strategy.AimsImprove compliance with RCEM guidance for safe administration, documentation and post-procedure monitoring following FIB.Employ QIP methodology to create a FIB protocol.Empower the junior SHO workforce to gain competence in FIB administration through structured teaching.Improve understanding of post-block monitoring in nursing and medical staff.Methods/DesignData collection identified the number of blocks administered to those presenting with fractured neck of femur in November 2019. Documentation and post-procedure monitoring were evaluated.Interventions were piloted in January 2020. These were: pre-made block packs, a block checklist sticker incorporating post-procedure monitoring chart and laminated ‘quick prompt’ guide.Nurse champions facilitated MDT teaching sessions and junior SHOs were empowered to gain competence in block administration through teaching sessions.Retrospective data from January 2020 was compared to November 2019, allowing us to establish the efficacy of changes.Abstract 127 Figure 1Results/ConclusionsOctober 2019 results demonstrated 59% of patients received a FIB, this increased to 78% in January 2020. Pre-intervention, 45% of patients had the correct dose of local anaesthetic. This increased to 79% post-intervention. Initially, documentation was correct in just 5% of cases, improving to 59% after re-auditing.Feedback from teaching sessions was positive with nursing staff better understanding the need for post-procedure monitoring. SHOs gained increased confidence delivering FIBs, freeing up senior doctors for other tasks.The new protocol has improved the administration of FIBs with better post-procedure care and standardised dosing of local anaesthetic. Interventions are embedded in departmental practice; this will be re-audited in 6 months. Following the transition to e-noting we are developing an electronic template to translate these successes onto the new system.

Management and outcome of the dislocated hip hemiarthroplasty

2018 ◽  
Vol 100-B (12) ◽  
pp. 1618-1625 ◽  
Author(s):  
J. R. Gill ◽  
B. Kiliyanpilakkill ◽  
M. J. Parker
Keyword(s):  
Closed Reduction ◽  
Case Series ◽  
Revision Arthroplasty ◽  
Post Injury ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Additional Surgery ◽  
Significant Difference ◽  
One Year ◽  
Excision Arthroplasty

Aims This study describes and compares the operative management and outcomes in a consecutive case series of patients with dislocated hemiarthroplasties of the hip, and compares outcomes with those of patients not sustaining a dislocation. Patients and Methods Of 3326 consecutive patients treated with hemiarthroplasty for fractured neck of femur, 46 (1.4%) sustained dislocations. Of the 46 dislocations, there were 37 female patients (80.4%) and nine male patients (19.6%) with a mean age of 83.8 years (66 to 100). Operative intervention for each, and subsequent dislocations, were recorded. The following outcome measures were recorded: dislocation; mortality up to one-year post-injury; additional surgery; residential status; mobility; and pain score at one year. Results Of 43 dislocations, 30 (70%) occurred within one month and 42 (98%) occurred within three months of hip fracture surgery. Seven (16%) of these patients were treated with a single closed reduction and sustained no further dislocations. Four (9%) were treated with open reduction and experienced no further dislocations. Three (7%) hips were left dislocated and the remaining 32 (74%) patients required additional surgery of further closed reduction, revision, or excision arthroplasty. The one-year mortality rates for patients treated with two or fewer reductions (open or closed), successful revision arthroplasty, and excision arthroplasty were 3/14 (21%), 1/7 (14%), and 8/14 (57%) respectively. The only statistically significant difference in mortality was the difference between patients who did not sustain a dislocation and those who did and were treated by excision arthroplasty (p = 0.03). Patients treated by excision arthroplasty had the greatest reduction in mobility scores and highest pain scores. The excision arthroplasty group also included the greatest proportion of patients not able to mobilize and the smallest proportion of patients remaining in their own home. Conclusion Most dislocations of hemiarthroplasties of the hip occur within one month of surgery. Closed reduction is generally unsuccessful. For those patients with unsuccessful closed reduction, revision arthroplasty should be considered when possible, as this results in a better functional outcome with a lower mortality than excision arthroplasty.

436 POSTOPERATIVE SYSTOLIC HYPOTENSION IN FRACTURED NECK OF FEMUR PATIENTS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
R Jones ◽  
J Cook ◽  
A Cannon
Keyword(s):  
General Practice ◽  
Recovery Room ◽  
Secondary Analysis ◽  
Vital Signs ◽  
Postoperative Mortality ◽  
Systolic Arterial Pressure ◽  
Small Sample ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
One Year

Abstract Introduction Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP 2) found an association between reduced intraoperative systolic arterial pressure (SAP) and postoperative mortality at five and 30 days. We sought to determine the incidence of hypotension in the postoperative period, rather than just intraoperatively, in a small sample of patients with fractured neck of femur. Method We performed a retrospective review of the notes, electronic vital signs and electronic general practice records from 40 patients with fractured neck of femur. We identified the latest SAP performed at their general practice (if done within one year before admission). We noted the pre-operative baseline SAP reading from the ward as well as the lowest SAP during several time periods: the pre-operative period; the fracture surgery; the recovery room; and during each 24-h period postoperatively until the fifth postoperative day. Results A SAP recording from general practice within the previous year was only accessible in 21 (53%) of patients, but where it was accessible, it was within 20% of the immediate preoperative SAP in 14 (66%) of patients. The incidence of relative hypotension (&lt; 80% preoperative SAP) was 54% in the operating theatre, 41% in the recovery room, 65% on the ward during the remainder of the first postoperative 24 h, 55% during postoperative day 2, 53% during day 3, 33% during day 4 and 41% during day 5. Conclusions Postoperative hypotension was common in our sample. In our analysis, the highest incidence was on the ward during the first 24 hours postoperatively. However, 41% of patients still had hypotension 5 days postoperatively.

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