Do Patients With Neck of Femur Fractures (NOFF) Experience Long Pre-Hospital Delays in the United Kingdom?

Background and objective It is well documented that prolonged preoperative delay is associated with increased morbidity and mortality among patients presenting with neck of femur fractures (NOFF). The target time from arrival to the emergency department (ED) to be transported to the theatre for these patients in England is 36 hours. However, the time before the patient arrives at the hospital is not often considered. In light of this, we aimed to assess the duration of the waiting period for NOFF patients before they are brought to the ED. Methods Data were collected retrospectively using IT and theatre systems at a single trust. A total of 223 consecutive NOFF patients undergoing operations in the six-month period between February and August 2020 were reviewed. Results The mean time for ambulance response was one hour and 50 minutes, whereas the time spent in the ambulance was one hour and 47 minutes and the total pre-hospital time was three hours and 37 minutes (range: 59 minutes to 14 hours and 41 minutes). The mean time from ED arrival to the theatre was 33 hours and one minute. The mean total preoperative time was 36 hours and 38 minutes. Conclusion The mean pre-hospital time of three hours and 37 minutes represents approximately 10% of the 36-hour national target. Pre-hospital time is often overlooked when considering the order of the list for the theatre. It may be possible to reduce morbidity and mortality by prioritising patients with a longer pre-hospital time, especially given our finding that some patients may wait up to 14 hours. We recommend that pre-hospital time be considered for all patients with NOFF.