Title : The missing link in Hip Fracture (HF) timelines: Impact of full admission work-up on time to theatre
Abstract:
Standard & Rationale: NICE guidelines recommend that patients with a fractured neck of femur undergo operative management within 36 hours of admission. Similarly, BOAST guidance for trauma in elderly patients emphasizes that surgery should enable full weight bearing for activities of daily living within the same time frame. In smaller District General Hospitals (DGHs) with high volumes of elderly trauma, achieving these targets on a single trauma list can be challenging. Where resource limitations preclude the introduction of a second, dedicated neck of femur trauma list, it is essential to identify modifiable factors contributing to delays. This audit explores whether delays in completing pre-operative investigations at admission impact time to surgery.
Method: Over a 3-week period, all patients admitted with a fractured neck of femur were audited. The following parameters were recorded:
1.Time to surgery
2.Time to first venepuncture
3.Time to complete a full set of admission investigations (ECG, chest X-ray, full blood count, renal profile, clotting profile, and two group and save samples). Patients were grouped based on whether surgery was performed within 36 hours, and their investigation timelines were compared.
Results: 57% of patients underwent surgery within 36 hours. In this group, 100% had all admission investigations completed in the emergency department. 43% of patients breached the 36-hour target. None of these had full investigation completion in the emergency department; only partial investigations were performed. There was no significant difference in time to surgery when comparing the time of first venepuncture alone.
Conclusion: Timely completion of all admission investigations, rather than the timing of the first test, is crucial. In a DGH setting, ensuring full pre-operative work-up is completed promptly ideally within the emergency department is a key factor in reducing time to theatre. This approach can support achieving weight- bearing surgical management within 36 hours of admission. The introduction of a suspected neck of femur flowchart-checklist was introduced at the DGH to help improve timely completion of pre-operative investigations in this patient cohort.
