Patient and hospital-level factors associated with time to surgery after hip fracture in Ireland: Analysis of national audit data 2016–2020

Walsh, Mary E.; Blake, Catherine; Walsh, Cathal; Brent, Louise; Sørensen, Jan

doi:10.1016/j.injury.2023.04.038

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…Our findings agree with the previous evidence exploring the relationship between transfer status and delays to surgery [11,[13][14][15][16], except for one Irish study which found no differences in the odds of achieving timely surgery between the two groups [12]. This could be because Ireland's geography and healthcare system varies from Scotland's, and they utilised a target time of 48 h. The study was also conducted ten years ago, when demands on orthopaedic services were less and patients were not as complicated [25].…”

Section: Discussionsupporting

confidence: 93%

“…This facilitated a substantial sample size, excellent data quality and a nationally representative cohort reflective of hip fracture care within a developed healthcare system. To our knowledge, this study is the first to investigate the association between transfer status and delays in surgical management for hip fractures in Scotland and contributes to the small international evidence base [11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, delayed surgery has previously been associated with adverse postoperative outcomes in large meta-analysis, including mortality rates, complications, and extended hospital stays [9,10]. While limited international studies have explored the associated between hospital transfer and delay in surgical management [11][12][13][14][15][16], none however have addressed the unique geographical challenges faced by Scotland and the associated large rural population, particularly in the Highlands and Islands. This means that several patients do not have direct access to hospitals with hip fracture services, and instead initially present to small local units designed to manage rehabilitation or minor injuries.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland: A Cohort Study

Lennox,

Myint,

Baliga

et al. 2024

JCM

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Background/Objectives: Hip fractures exert a substantial burden on hospital systems. Within Scotland 20% of the population resides rurally, warranting investigation of how this impacts prompt access to surgical care. This study aims to determine whether indirect hospital admission via hospital transfer affects the likelihood of surgical management within 36 h for hip fracture patients. Methods: A retrospective cohort study was performed. This used Scottish Hip Fracture Audit data including patients aged ≥50 split into two propensity matched groups based on their transfer status. Descriptive analysis compared patient characteristics. Regression assessed achieving surgery within 36 h of admission in the unmatched and matched cohorts. Secondary outcomes included time to surgery, mortality, mobilization, returning to residence and length of stay. A sensitivity analysis was undertaken to assess for residual confounding effects. Results: The unmatched analysis included 20,132 patients. Transfer patients were younger (p = 0.007) and less-comorbid (p < 0.001). In the matched population, 711 (63.6%) transfer patients had surgery with 36 h of presentation to hospital, compared to 852 (75.3%) non-transfer patients. Transfer patients had 43% reduced odds of timely surgery (OR (95% CI) 0.57 (0.48 to 0.69); p < 0.001). No disparities emerged in mortality, mobilisation or returning to residence., Transfer patients experienced a significant increase in length of stay in hospital (median (IQR) 16 (8 to 33) vs. 13 (8 to 30); p = 0.024). Conclusions: Hospital transfer is associated with significantly reduced odds of timely surgery, a longer time to surgery and longer length of stay. Development of structured network pathways that minimize delay to transfer are required to potentially optimize outcomes and reduce associated cost.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland: A Cohort Study

Lennox,

Myint,

Baliga

et al. 2024

JCM

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Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures

Schultz,

Eppler,

Shapiro

et al. 2024

Hand (New York, N,Y.)

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Background: Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures. Methods: We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain. Results: We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, “I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion,” which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains. Conclusion: Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

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Delirium and Cognitive Screening in National Hip Fracture Registries: Scoping Review Protocol

Merriman,

Penfold,

Brent

et al. 2024

HRB Open Res

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Background Delirium and cognitive impairment are common in hip fracture populations and are associated with significant adverse patient outcomes. National hip fracture registries facilitate improvements in patient outcomes and care quality, such as reduced mortality and the development of specialist multidisciplinary services. However, there is substantial variation in the data collected and reported in relation to delirium and cognition, which impedes international comparison and may reduce quality of care. Objective This scoping review aims to identify delirium and cognition data items currently collected by hip fracture registries internationally, to identify associated registry guidance that exists for the administration of delirium and cognitive screening tools, and report outcomes of these data items across the most recently published annual reports of identified hip fracture registries. Methods This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Relevant websites such as the Fragility Fracture Network (FFN) will also be searched. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third researcher. Data extraction and synthesis will be conducted by one reviewer and checked for accuracy and omissions by another. The scoping review findings will be informed and validated through engagement with the FFN Hip Fracture Audit Special Interest Group. Conclusion By identifying existing heterogeneity in delirium and cognitive screening tool use and administration, it is hoped that administration and specific screening tool use will become standardised to optimise comparability across countries and ensure that high quality and reliable data are included across international registry reports.

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Patient and hospital-level factors associated with time to surgery after hip fracture in Ireland: Analysis of national audit data 2016–2020

Cited by 3 publications

References 26 publications

The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland: A Cohort Study

The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland: A Cohort Study

Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures

Delirium and Cognitive Screening in National Hip Fracture Registries: Scoping Review Protocol

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