Grant-Freemantle Marc C, Kenyon Robert M, Gibbons John, Flynn Sean O, Davey Martin, Burke Neil
Trauma and Orthopaedics, Beaumont Hospital, Dublin, IRL.
Trauma and Orthopaedics, Royal College of Surgeons, Dublin, IRL.
Cureus. 2020 Jan 28;12(1):e6794. doi: 10.7759/cureus.6794.
Introduction The British Orthopaedic Association and British Geriatric Association Blue Book guidelines for patients presenting acutely with a hip fracture stipulate that the patient should be admitted to an acute orthopedic ward within four hours of presentation to the emergency department (ED). Materials and methods A retrospective review of all patients who presented to the ED with a hip fracture diagnosed on plain film X-Ray over an eight-week period by a single auditor. Time of arrival, time to X-ray, time of blood draw, time to orthopedic referral, time to orthopedic review, and time to arrival at the orthopedic ward were documented. A policy change stipulating that orthopedics on call would prospectively review potential hip fracture patients prior to definitive workup was initiated. The same parameters were re-audited following this intervention over a six-week period. Results Pre-intervention, the mean time to orthopedic review was 83 minutes with a mean time to ward of 417 minutes. Post-intervention, the mean time to orthopedic review was 76 minutes with a mean time to ward of 333 minutes. When orthopedic trainees were on call, the mean time to review was 37.5 minutes with a mean time to ward of 294 minutes. Conclusions While we were able to demonstrate an improvement in orthopedic response times, this did not significantly improve time to ward transfer. This highlights a number of other areas that need to be optimized to improve compliance with best practice guidelines.
引言 英国骨科协会和英国老年医学协会针对急性髋部骨折患者的蓝皮书指南规定，患者应在就诊于急诊科（ED）后的4小时内被收入急性骨科病房。材料与方法 由一名审核员对在八周内就诊于ED且经X线平片诊断为髋部骨折的所有患者进行回顾性研究。记录到达时间、进行X线检查的时间、采血时间、转至骨科的时间、接受骨科检查的时间以及到达骨科病房的时间。实施一项政策变更，规定随叫随到的骨科医生在进行最终检查之前要对潜在的髋部骨折患者进行前瞻性评估。在这一干预措施实施后的六周内，对相同参数进行重新审核。结果 干预前，接受骨科检查的平均时间为83分钟，到达病房的平均时间为417分钟。干预后，接受骨科检查的平均时间为76分钟，到达病房的平均时间为333分钟。当骨科实习医生随叫随到的时候，检查的平均时间为37.5分钟，到达病房的平均时间为294分钟。结论 虽然我们能够证明骨科反应时间有所改善，但这并未显著缩短转至病房的时间。这凸显了其他一些需要优化的领域，以提高对最佳实践指南的依从性。
