Why Still in Hospital After Hip Fracture Surgery?

Study Overview
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Brief Summary
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At our institution, hip fracture patients are admitted and treated according to a fast track patient pathway. The aim of this study is to identify areas of this patient pathway that can be improved. To achieve this, the study will investigate the underlying reasons for the continued need for hospitalization on the consecutive days after hip fracture surgery.

Detailed Description
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The study will be conducted at the orthopedic department, Akershus University Hospital, as a prospective observational study and will include approximately 200 consecutive hip fracture patients. The patients will be evaluated once daily for the fulfillment of predefined discharge criteria. If the discharge criteria are not met or if the criteria are met but the patient is not discharged in spite of this the underlying reason(s) are recorded.

Official Title
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Why Still in Hospital After Hip Fracture Surgery?

Conditions
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Hip Fractures

Intervention / Treatment
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* Other: Fast track patient pathway


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Operated at the orthopedic department, Akershus University Hospital, for a hip fracture Exclusion Criteria: Lack of written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Fast track patient pathway|Prehospital services establish a working diagnosis of hip fracture and initiate first line treatment. In the emergency department a specially trained nurse triages the patient. Patients without signs of other acute disease or trauma and who have not previously been operated in the same hip are directly transported to the x-ray suite. The x-rays are reviewed by the radiographer and in case of an obvious fracture of the hip the patient is transported directly to the orthopedic ward where the patient is received by a nurse and seen by an orthopedic surgeon. The pathway includes standard procedures for blood sampling, pain relief, including a fascia iliaca compartment block, intravenous fluids, transfusion triggers, management of anticoagulants and premedication. The pathway puts focus on prevention of pressure sores, a short preoperative fasting period and early mobilization. Screening tools are used to assess for delirium, nutritional status and fall risk.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Factors necessitating hospitalization after hip fracture surgery | Recorded as: acute anemia, delirium, medical complications, pain, dizziness, nausea/vomiting, logistical reasons, unwillingness to be discharged, other (specified as free text) | Recorded using a check-list once daily from first day after hip fracture surgery until discharge from the orthopedic department, typically between 1 to 14 days after hip fracture surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of patients discharged to their preoperative level of care |  | At hospital discharge, typically between 1 to 14 days after hip fracture surgery | 
| Length of hospital stay | Length of hospital stay in days, stratified after type of operation | At hospital discharge, typically between 1 to 14 days after hip fracture surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fast track