Barker Benjamin C, McDonnell Stephen
School of Clinical Medicine, University of Cambridge, Cambridge, GBR.
Trauma and Orthopaedics, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR.
Cureus. 2024 Oct 1;16(10):e70630. doi: 10.7759/cureus.70630. eCollection 2024 Oct.
The National Institute for Health and Care Excellence (NICE) introduced guidelines in 2011 for the management of hip fractures in patients over the age of 65. NICE CG124 recommended different procedures depending on the demographics of the patient and fracture pattern. In terms of compliance in 2019, Addenbrooke's Hospital (ADH) was found to be in line with the national average, although room for improvement was noted. The aim of this study was to identify and address areas of substantial non-compliance at ADH. A total of 1636 patients who sustained a hip fracture between 2017 and 2020 and who subsequently underwent surgery at ADH were retrospectively analysed. We collected data from the National Hip Fracture Database (NHFD), digital medical records, and digital imaging systems. We then amended the clerking proforma by adding a 'smart phrase' and re-analysed another 543 patients who attended ADH following hip fracture between 2021 and 2022, using the same data collection methods. From 2017-2020, total adherence to CG124, Section 1.6, was 76.04%. Our results demonstrated that 56.43% of all hip fracture patients indicated for total hip arthroplasty (THA) did not have documented consideration for the procedure. In 2021-22, following the addition of our 'smart phrase,' we made to the clerking proforma, total adherence improved to 87.43%, with only 42.11% of THA-indicated patients lacking documented consideration of the procedure, down from 65.41% in 2020. The use of our smart phrase decreased during the follow-up without a corresponding drop in compliance. In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated. However, we have demonstrated that we can increase NICE guideline compliance by standardising and encouraging formal documentation of the decision-making process. As electronic patient record (EPR) systems become more widespread, we have shown how 'smart phrases' can be used to generate change and increase compliance, even over a short period of time.
英国国家卫生与临床优化研究所（NICE）于2011年出台了针对65岁以上髋部骨折患者管理的指南。NICE临床指南124根据患者的人口统计学特征和骨折类型推荐了不同的治疗方法。就2019年的合规情况而言，阿登布鲁克医院（ADH）被发现与全国平均水平相符，不过仍有改进空间。本研究的目的是识别并解决ADH存在严重不合规的领域。对2017年至2020年间发生髋部骨折且随后在ADH接受手术的1636例患者进行了回顾性分析。我们从国家髋部骨折数据库（NHFD）、数字医疗记录和数字成像系统中收集数据。然后，我们通过添加一个“智能短语”对病历记录模板进行了修改，并使用相同的数据收集方法对2021年至2022年间因髋部骨折到ADH就诊的另外543例患者进行了重新分析。2017年至2020年期间，对CG124第1.6节的总体依从率为76.04%。我们的结果表明，所有被建议进行全髋关节置换术（THA）的髋部骨折患者中，有56.43%没有关于该手术的记录在案的考量。在2021年至2022年，在我们对病历记录模板添加了“智能短语”之后，总体依从率提高到了87.43%，只有42.11%被建议进行THA的患者缺乏该手术的记录在案的考量，低于2020年的65.41%。在随访期间，我们的智能短语的使用减少了，但合规情况并未相应下降。2023年1月，NICE CG124发生了变化，使得我们在ADH所做的改变过时了。然而，我们已经证明，我们可以通过标准化并鼓励对决策过程进行正式记录来提高对NICE指南的依从性。随着电子病历（EPR）系统越来越普及，我们展示了“智能短语”如何能够带来改变并提高依从性，即使是在短时间内。
