Abstract
Background
This study highlights the multiple sources of delay along a hip fracture clinical pathway. The national recommendation is that ‘patients with a hip fracture should be admitted within 4 hours of arrival at the Emergency Department to which they first presented’.
Methods
Granular analysis and process mapping of all available hospital and ‘Irish Hip Fracture Database’ data for a 2-month period were used to highlight and compare causes of delay.
Discussion
We identified numerous sources of delay, occurring at every point along the pathway, emphasising the complexity of providing acute integrated care. There was no single stage that persistently contributed to the delay in the patient pathway. The focus is now to achieve marginal gains in each area. Increased staff and resources to the front line are a clear solution but this is complex to achieve.
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References
Online Document Ahern E, Brent L, Connolly A et al Irish Hip Fracture Database National Report (2017) Page 28 (http://s3-eu-west-1.amazonaws.com/noca-uploads/general/Irish_Hip_Fracture_Database_National_Report_2017_FINAL.pdf). Accessed October 2019
Online Document Moore M, Walsh M, Hassan T Version 1, September 2018 Irish Association of Emergency Medicine Clinical Guideline Management of patients with suspected hip fracture in the emergency department (http://www.iaem.ie/wp-content/uploads/2019/04/IAEM-CG-NOF.pdf). Accessed October 2019
Online Document Murphy R, Meighan V Version 1, November 2018 Irish Association of Emergency Medicine Clinical Guideline Fascia iliaca compartment block for proximal femur fracture in the emergency department (http://www.iaem.ie/wp-content/uploads/2019/04/IAEM-CG-FINB.pdf). Accessed October 2019
Online Document The Royal College of Emergency Medicine Fractured neck of femur clinical audit 2017/18 National Report. https://www.rcem.ac.uk/docs/Fractured%20Femur%202017_18%20National%20Report%20(Oct%202018).pdf. Accessed October 2019
Journal Article McGowan H, Gopeesingh H, O’ Kelly P July/August 2018 Irish Medical Journal Emergency department overcrowding and the full capacity protocol crossover study: what patients who have experienced both think about being an extra patient in the emergency department or on a ward. http://imj.ie/july-august-2018-o-p3-emergency-department-overcrowding-and-the-full-capacity-protocol-cross-over-study-what-patients-who-have-experienced-both-think-about-being-an-extra-patient-in-the-emergenc/. Accessed October 2019
Online Document Irish Medical Organisation position paper on acute hospital bed capacity March 2005. https://www.imo.ie/policy-international-affair/documents/policy-archive/IMOPP-Acute-Hospital-Bed-Capacity.pdf. Accessed October 2019
Journal Article Morley C, Unwin M, Peterson GM (2018) Plos One Emergency department crowding: a systematic review of causes, consequences and solutions. https://pmc/pmc/articles/PMC6117060/#pone.0203316.ref002. Accessed October 2019
Journal Article Black D, Pearson M (2002) The British Medical Journal Average length of stay, delayed discharge, and hospital congestion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124147/. Accessed October 2019
Journal Article Plunkett P (2006) European Journal of Emergency Medicine Blocked bothered and bewildered am i. https://journals.lww.com/euro-emergencymed/Citation/2006/04000/Blocked,_bothered_and_bewildered_am_I.1.aspx. Accessed October 2019
Journal Article Cooper C, Campion G, Melton LJ 3rd (1992) Osteoporosis International Hip-fractures in the elderly: a worldwide projection https://www.ncbi.nlm.nih.gov/pubmed/1421796/. Accessed October 2019
Online Journal Shenouda M, Silk Z, Radha S, et al (2017) The Open Orthopaedics Journal The introduction of a multidisciplinary hip fracture pathway to optimise patient care and reduce mortality: a prospective audit of 161 patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420169/. Accessed October 2019
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Luke, C., O’ Rourke, E., Keeling, P. et al. Causes of delay on a hip fracture pathway—a retrospective single-centre analysis. Ir J Med Sci 190, 1035–1040 (2021). https://doi.org/10.1007/s11845-020-02419-9
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DOI: https://doi.org/10.1007/s11845-020-02419-9