Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)
Publication Name
Gerontology
Abstract
Introduction: Hip fracture in older adults results in signifi- cant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group; how- ever, uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes. Methods: This con- trolled pre- and post-test study was conducted from June 2019–June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs. Results: There were 565 cases in- cluded for analysis. After implementation of eHIP (the post period), 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presen- tation (pain and cognitive assessment) increased by 23%, and unrestricted mobilisation within 24 h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2–57%), and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change. Discussion/Conclusion: eHIP, a hip fracture care program incorporating evidence- based behaviour change theory, resulted in sustained im- provements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.
Open Access Status
This publication is not available as open access
Volume
70
Issue
5
First Page
536
Last Page
543
Funding Number
ACI/D18/4682
Funding Sponsor
Illawarra Health and Medical Research Institute