Best practice of patient with a hip fracture (Plenary)

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

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Predictors of in-hospital mortality post hip fracture in Ireland 2013-2017

European Journal of Public Health ◽

10.1093/eurpub/ckz187.224 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Ferris ◽

L Brent ◽

J Martin ◽

P Crowley ◽

T Coughlan

Keyword(s):

Multivariate Analysis ◽

Hip Fracture ◽

Hospital Mortality ◽

Hip Fractures ◽

Best Practice ◽

Secondary Analysis ◽

Specific Reference ◽

Ageing Population ◽

The Republic ◽

Organisational Factors

Abstract Background Hip fractures are associated with considerable mortality, morbidity and healthcare expenditure. There are approximately 3,500 hip fractures in Ireland per annum with this figure set to increase considerably over the coming years due to the ageing population. Internationally, mortality following hip fracture is approximately 10% at 1 month and 30% at 1 year, with less than half of survivors regaining their preoperative level of function. The authors aimed to identify the determinants of in-hospital mortality post hip fracture in the Republic of Ireland 2013-2017, with specific reference to the Irish Hip Fracture Standards. Methods A secondary analysis of 15,603 patients in the Irish hip fracture database was conducted. Results 31% (n = 4,769) were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). The largest proportion of hip fractures occurred in the 80-89 age category, with 72.3% (n = 4,600) of these being female. Median in-hospital mortality was 4.7% (n = 711) (Range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only 4 remained statistically significant on multivariate analysis [mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70, p < 0.000), pre-fracture mobility (OR 0.84, 95% CI 0.79-0.89, p < 0.000), gender (OR 0.56, 95% CI 0.41-0.76, p < 0.000) and age (OR 1.05, 95% CI 1.03-1.06, p < 0.000)]. Conclusions Older males with poor pre-fracture mobility who were not mobilised the day of/after surgery had the highest risk of in-hospital mortality. The ability to be mobilised on the day of/after surgery is a good composite measure of both patient and organisational factors in hip fracture care. This research supports the inclusion of mobilisation on the day of/after surgery as a new formal best practice standard. Key messages Patients not mobilised on the day of/after surgery are 46% more likely to die in hospital. In-hospital mortality of 4.7% in Ireland is comparable internationally. None of the IHFSs significantly influenced in-hospital mortality after multivariate analysis, but may well affect other outcomes such as ability to return home.

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Discharge after hip fracture surgery by mobilisation timing: secondary analysis of the UK National Hip Fracture Database

Age and Ageing ◽

10.1093/ageing/afaa204 ◽

2020 ◽

Author(s):

Katie J Sheehan ◽

Aicha Goubar ◽

Orouba Almilaji ◽

Finbarr C Martin ◽

Chris Potter ◽

...

Keyword(s):

Hip Fracture ◽

Best Practice ◽

Average Rate ◽

Secondary Analysis ◽

Fold Increase ◽

Competing Risk ◽

Hospital Death ◽

Hip Fracture Surgery ◽

Risk Of Death ◽

Fracture Surgery

Abstract Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30 days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between 1 January 2014 and 31 December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 h of surgery) and those mobilised late, accounting for potential confounders and the competing risk of in-hospital death. Results A total of 106,722 (79%) of patients first mobilised early. The average rate of discharge was 39.2 (95% CI 38.9–39.5) per 1,000 patient days, varying from 43.1 (95% CI 42.8–43.5) among those who mobilised early to 27.0 (95% CI 26.6–27.5) among those who mobilised late, accounting for the competing risk of death. By 30-day postoperatively, the crude and adjusted odds ratios of discharge were 2.36 (95% CI 2.29–2.43) and 2.08 (95% CI 2.00–2.16), respectively, among those who first mobilised early compared with those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a 2-fold increase in the adjusted odds of discharge by 30-day postoperatively. We recommend inclusion of mobilisation within 36 h of surgery as a new UK Best Practice Tariff to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

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Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management

Physical Therapy ◽

10.2522/ptj.20100310 ◽

2011 ◽

Vol 91 (10) ◽

pp. 1490-1502 ◽

Cited By ~ 11

Author(s):

Susie Thomas ◽

Shylie Mackintosh ◽

Julie Halbert

Keyword(s):

Hip Fracture ◽

Physical Therapy ◽

Acute Care ◽

Best Practice ◽

Physical Therapists ◽

Physical Therapist ◽

Acute Care Hospital ◽

Early Mobilization ◽

Care Hospital ◽

Retrospective Case

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

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Improving hip fracture care: striving for excellence

Reviews in Clinical Gerontology ◽

10.1017/s0959259813000075 ◽

2013 ◽

Vol 23 (3) ◽

pp. 223-233 ◽

Cited By ~ 4

Author(s):

N Nandi ◽

M Maddula ◽

O Sahota

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Older People ◽

Best Practice ◽

Enhanced Recovery ◽

Fracture Care ◽

Enhanced Recovery Pathway

SummaryHip fracture is a common and potentially devastating injury that occurs mainly in older people. The incidence is predicted to rise by 30% in the next 10 years alone. Many of those who recover suffer a loss of mobility and independence. There is growing emphasis to improve the care of patients sustaining hip fracture, especially in those with concurrent cognitive impairment. This review focuses on current best practice as well as several key areas of management, including analgesia, anaemia and nutrition. In doing so, we hope to identify interventions that may form the basis of a future Enhanced Recovery Pathway dedicated to hip fracture care.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0151 ◽

2016 ◽

Vol 98 (6) ◽

pp. 422-424 ◽

Cited By ~ 3

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.

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