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.

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

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.

Clinical pathway for fractured neck of femur: a prospective, controlled study

2000 ◽  
Vol 172 (9) ◽  
pp. 423-426 ◽  
Author(s):  
Peter F M Choong ◽  
Anna K Langford ◽  
Michelle M Dowsey ◽  
Nick M Santamaria
Keyword(s):  
Clinical Pathway ◽  
Controlled Study ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Prospective Controlled Study

scholarly journals Impact of COVID-19 on clinical outcomes for patients with fractured hip

2020 ◽  
Vol 1 (11) ◽  
pp. 697-705
Author(s):  
Damir Rasidovic ◽  
Imran Ahmed ◽  
Christopher Thomas ◽  
Peter K-U Kimani ◽  
Peter Wall ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Final Analysis ◽  
World Health ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Post Surgery ◽  
Risk Of Mortality ◽  
Health Organization ◽  
The Uk ◽  
Neck Of Femur Fracture

Aims There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected. Cite this article: Bone Joint Open 2020;1-11:697–705.

Clinical pathway for fractured neck of femur: a fractured pathway or crazy paving?

2000 ◽  
Vol 173 (5) ◽  
pp. 277-277
Author(s):  
Stephen F WIison ◽  
Nicholas P Colllns ◽  
Brett P Gardiner
Keyword(s):  
Clinical Pathway ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur
Sign in / Sign up

Export Citation Format

Share Document