Audit: initial assessment and management of fracture neck of femur patients in the emergency department and the “Fast Track” system

Abstract

Patients were split into further subgroups; those having early surgery <48 h (51%) vs. late surgery >48 h (49%), those who were treated for an extracapsular fracture vs. those treated for an intracapsular fracture, then divided again into early surgery vs. late surgery. We found the larger Hb drop (mean 3.2 g/dL) in the early surgery group vs. 2.35 g/dL in the late group with no significant difference in blood loss between groups (p = 0.074). Average length of stay was 21.13 (range 5-58) in the early and 22.93 days in the late (range 8-61) with no significant difference between groups (p = 0.42). On comparison of the extracapsular group vs. the intracapsular group, average Hb drop 3.41 vs. 2.31 respectively (p = 0.020), the extracapsular group had longer stays in hospital 24.5 days vs. 19.8 days (p = 0.42) and had more post surgery complications.Conclusion: We found the patients treated with early surgery lost more blood and suffered more post operative complications, this was true for the extracapsular group showing a significant difference in blood loss when compared with the intracapsular group along with an increased length of stay.We recommend an appropriate pre-operative management strategy for this patient subgroup after identifying the patient subgroups most at risk.Background: Hip fracture is a common condition mainly affecting the elderly, and is a significant cause of mortality and morbidity. The number of hip fractures treated is rising annually. In 1997, 866,000 people in England and Wales required inpatient treatment for neck of femur fracture; of these, 75% were over 75 years of age (Audit Commission 2000). Effective and efficient multidisciplinary management of patients with hip fractures is essential from both a clinical and cost perspective. Guidelines have been developed to improve care for these patients.Aim: Currently, there is no standardised protocol being followed in the Colchester NHS Trust. The purpose of our audit was to assess the efficiency of the "Fast Track" hip fracture system in the trust, using the SIGN guidelines as our audit standards. We paid particular attention to initial assessment and management of hip fracture patients before transfer to the orthopaedic ward.Methodology: We developed a data collection tool to record information, and retrospectively reviewed the case notes of 55 patients with fractured hips admitted through the emergency department between February and August 2009.Results: In the initial assessment 81% of patients had baseline observations taken, 74% were given adequate analgesia, 81% were fluid resuscitated, 18% were assessed for pressure sore risk, and no one had their cognitive function screened. During the medical assessment, 15% had their previous functional ability assessed, 37% had their social situation assessed, 61% had their past medical history taken and only 18% had their acute medical problems reviewed and addressed. There was no clear documentation of whether medically unwell patients had direct referral to medical or ortho-geriatrician teams...

Application of lean management after audit of Medical Records Department in a COVID19 dedicated center during the COVID pandemic

“…In a study conducted by Chamisa et al, 10 it is documented that 61% of the files had examination details . In another study done by Osei-Kufuor et al, 11 it was revealed that 61% had no detailed examination reports .…”