Abstract
BackgroundThe socioeconomic burden caused by fragility fractures is well recognised in today’s ageing society, with hip fractures making a notable contribution. There is a significant national drive for secondary-prevention bone-protection prescription given the high morbidity and mortality rates of femoral neck fractures. A Specific, Measurable, Achievable, Relevant, Time-bound (SMART) aim was constructed to reach the gold standard in a level 2 trauma centre, utilising the Model for Improvement methodology.MethodologyBaseline data were collected for 79 consecutive patients admitted with a neck of femur fracture. A total of 14% were managed with bone-protection plans. The root cause analysis identified three elements having a major impact on the prescription of secondary bone-protection medication: the lack of awareness, education, and a structured multidisciplinary team (MDT) approach. Appropriate plan-do-study-act cycles were implemented and change audited.ResultsFollowing cycles one and two, the mean percentage of patients managed with bone-protection plans increased from 14% to 44% and 76%, respectively. A statistical process control chart demonstrated positive change for each cycle, with p-values of <0.01 and <0.001, respectively. After our final cycle, 100% of patients suffering from a femoral neck fracture were being managed with appropriate bone-protection plans according to the Royal College of Physicians’ national hip fracture database. We observed 100% sustainability two years later, despite the coronavirus disease 2019 pandemic service disruptions and redeployment of staff.ConclusionsDepartmental awareness and education played an important role in this quality improvement project. The ultimatum and sustainability intervention was ‘responsibility charting’ among the MDT: setting clear roles within the team to deliver better patient care.
Highlights
70,000 hip fractures occur annually in the United Kingdom, with care totalling over two billion pounds [1]
Following cycles one and two, the mean percentage of patients managed with bone-protection plans increased from 14% to 44% and 76%, respectively
100% of patients suffering from a femoral neck fracture were being managed with appropriate bone-protection plans according to the Royal College of Physicians’ national hip fracture database
Summary
70,000 hip fractures occur annually in the United Kingdom, with care totalling over two billion pounds [1]. Hip fractures are a serious consequence of falls in the elderly, with a mortality of 10% at one month and 30% at one year [2,3]. Sustaining a fragility fracture at least doubles the risk of future fractures [1], with up to 11% of patients sustaining a second fracture in the first year [4,5]. Secondary prevention of hip fractures is of great importance. All patients sustaining a hip fracture should be treated with bisphosphonates [6], which reduces the relative risk of recurrent fractures by up to 35% [7]. Other medical treatments in secondary prevention can be used, including denosumab, vitamin D, and calcium supplementation. A Specific, Measurable, Achievable, Relevant, Time-bound (SMART) aim was constructed to reach the gold standard in a level 2 trauma centre, utilising the Model for Improvement methodology
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