Hip Fracture Management in a Major Trauma Centre: The Impact of 'Smart Phrase' Integration Into Electronic Clerking on Culture and Adherence to Guidelines.

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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 In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated.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.