153 Challenges and facilitators experienced by professionals recording long-term outcomes after hip fracture: a Consolidated Framework for Implementation Research qualitative study

Abstract

Abstract Background Older people with hip fracture can experience slow recovery. Hospitals in Ireland record inconsistent information about survival, recovery, and treatment adherence up to one year after fracture. The Irish Hip Fracture Database aims to implement outcome fields to standardise this information. This study aimed to explore local facilitators and challenges experienced by hospital-based health professionals in Ireland to long-term hip fracture outcome recording. Methods Health care professionals who had experience of collecting long-term outcomes after hip fracture in Irish acute and rehabilitation hospitals were identified through a systematic literature review and advertisement. They were sampled purposively by profession and geographical location. Semi-structured interviews and focus groups were conducted online, audio-recorded, and transcribed. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Research Ethics Committee approval was received. Results There were 21 participants: eight geriatricians, six physiotherapists, three nurses, three orthopaedic surgeons and an anaesthetist. Challenges and facilitators across five CFIR domains were identified. 1) Characteristics of Individuals: Patient-focused, persistent, and flexible professionals have driven long-term outcome recording locally. 2) Innovation characteristics: Patient contact mode and complexity of information recorded affected activity difficulty. 3) Process: Protected space, time, administrative support, role clarity and staff consistency aided sustainability. 4) Inner setting: Support of local governance groups, senior clinicians and management facilitated activity. 5) Outer setting: Professional collaborations between hospitals and international exemplars inspired activity, while perceived policy focus on acute data hindered prioritisation of long-term outcome recording. Conclusion While site-specific circumstances are evident, common challenges and facilitators have been identified to recording of long-term outcomes after hip fracture by hospital-based health professionals across Ireland. Education and implementation strategies are currently being developed based on these findings, with input from patients and international experts. Further research will evaluate implementation outcomes including feasibility of specific data fields.