ABSTRACT
Peri-operative hip fracture care is a core service that must be maintained at the highest standard despite the COVID-19 pandemic. We re-audited our hip fracture pathway in January 2021 as a litmus test of the quality of hip fracture service during challenging times, in comparison with an inaugural January 2020 audit and national recommendations [1]. This identified areas requiring improvement;the findings were presented at the local governance meeting and used to develop a quality-improvement (QI) project to embed good clinical practice and systems resilient to external stresses. The first QI cycle focused on three specific peri-operative parameters. Methods Key parameters identified for improvement were intra-operative fascia iliaca/ femoral nerve blocks, tranexamic acid administration and near-patient haemoglobin measurement in the post-anaesthesia recovery unit. The first 2-week QI cycle was carried out in July 2021. QI interventions comprised of conspicuous yellow laminated reminders on the worktops of the anaesthesia room and recovery areas of the orthopaedic theatres, full engagement of the theatres' multidisciplinary team (MDT), discussions of rationale and data with individual anaesthetists and anaesthetic assistants, and empowering the team to remind each other of the best practice guidance. Results The 2-week cycle captured 17 patients reflecting local incidence. Discussion Our January 2021 audit highlighted issues requiring attention, likely influenced by the challenges of COVID-19. Presentation of data to anaesthetists established a consensus to improve hip fracture care. The subsequent QI cycle was carefully planned to involve the entire MDT including dialogue with theatre managers to encourage participation in the initiative, and integrated interventions into the existing workflow of trauma lists. The successful results of the first cycle were disseminated to promote sustained engagement, and further interventions such as incorporation into surgical safety checklists as a cognitive aid are in progress. We intend to steadily improve on the progress to instil good practices, build resilient systems and sustain high-quality peri-operative care for our hip fracture patients.