Bristol Medical School, University of Bristol, Bristol, UK.
Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK.
BMC Musculoskelet Disord. 2023 Feb 16;24(1):128. doi: 10.1186/s12891-023-06164-9.
Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care.
Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway.
Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team.
Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.
髋部骨折是一种破坏性损伤，医疗和社会保健费用高昂。尽管有国家标准和指南，但医院在髋部骨折护理和患者结果方面的服务提供仍存在很大差异。这项定性研究旨在确定可以针对的组织流程，以减少服务提供的差异并改善患者护理。
对英国四家医院的 40 名髋部骨折护理人员进行了访谈。对 23 份针对表现不佳的髋部骨折服务的英国矫形协会匿名报告进行了分析。对两个数据源进行主题分析后，主题被转置到髋部骨折护理路径的各个领域。
有效的术前护理需要提前预警患者入院，并确保急诊部门有工作人员进行评估、检查和止痛。医疗和外科团队之间关于手术的协调决策是关键，需要制定策略以确保灵活但高效的创伤清单。矫形骨科服务是有效服务提供的核心，需要进行协作工作并监督初级医生、专科护士和治疗师。通过连接的信息和技术系统，通过多学科会议促进信息共享。通过将髋部骨折路径文档嵌入入职和培训中，并确保整个团队一致使用，从而改善了服务提供。医院行政领导在优先考虑髋部骨折护理和倡导服务改进方面非常重要。共同拥有该途径并定期开会的指定专业领导积极指导服务，并定期监测绩效，调查失误并定期向多学科团队反馈。
研究结果强调了参与多学科护理路径的所有团队和部门的代表性的重要性，以提供综合的髋部骨折护理。确定了护理提供的复杂的、潜在可改变的障碍和促进因素，为改善有效的髋部骨折护理提供了建议，并在重新设计和实施服务改进时为医院服务提供了帮助。
