Hospital-specific improvement approaches may reduce delay of surgery for hip fractures
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Key takeaways:
- Results showed hospital-specific approaches may reduce surgical delay of hip fractures.
- Researchers found no two sites shared the same profiles in characteristics and reported determinants of time to surgery.
Results from a mixed-methods qualitative study showed improvement strategies based on hospital-specific contextual determinants of time to surgery may reduce delays in time to surgery for patients with hip fractures.
“The differences in site factors highlight the uniqueness of this problem and the importance of understanding each hospital’s context-specific challenges in order to improve patient care for those with hip fractures,” Robin N. Kamal, MD, MBA, associate professor of orthopedic surgery at Stanford University, told Healio.
From May 2021 to August 2022, researchers identified contextual determinants of time to surgery for adults with hip fractures. According to the study, the mixed-methods approach involved qualitative interviews with stakeholders involved in hip fracture care (n = 34) and quantitative surveys completed by orthopedic surgeon leaders (n = 23).
Overall, researchers found that the most common contextual determinants of time to surgery were availability, care coordination, improvement climate and incentive structure.
However, according to the study, “no sites shared identical profiles in characteristics and reported determinants of time to surgery.”
In the quantitative survey portion of the study, researchers found that lack of OR availability, having a soft protocol for coordination of care, lack of power change and lack of incentive for urgent cases were the most commonly reported barriers to reducing time to surgery.
According to the study, OR availability, formal co-management systems, physician champions with a focus on urgent surgery and programs supporting improvement work were the most common facilitators of reduced time to surgery.
“Our study findings of common challenges in getting hip fracture patients to the OR in less than 24 hours was validated by survey findings from 23 hospitals across the country, which all experienced some combination of these barriers,” Kamal said. “There is no national-level platform for hospitals to communicate their strategies to overcome barriers, hindering our ability to share our successes to benefit hip fracture patients. To address this, we have created the [Surgical Wait Times and Outcomes for Fracture Treatment] SWIFT Initiative. We are hopeful that this initiative, currently with 34 hospitals engaged, will continue to grow so we can share approaches to improve hip fracture care in the U.S.”
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