Time to surgery for hip fracture patients in a rural orthopaedic referral hospital.

PROBLEM: It is well established that shorter surgical waiting time for hip fracture patients improves outcomes. We identify and quantify time to surgery for hip fracture patients in a rural hospital. DESIGN: Retrospective observational study. SETTING: : A sixty-bed rural referral hospital with an orthopaedic service. Data were collected for 57 patients 50 years and older who had surgery for Muller AO type 31-A and 31-B fractures at Bega Hospital in 2012. KEY MEASURES FOR IMPROVEMENT: Time to surgery from presentation was compared for patients who presented directly to Bega hospital to those that were transferred from a peripheral hospital. STRATEGIES FOR CHANGE: To quantify contributing factors to surgical delay will help identify areas for future improvement. EFFECTS OF CHANGE: Delay to surgery from presentation was significantly greater for transferred patients (58 hours), compared with direct presentations (41 hours). Mean time for patient transfer was 23 hours. Thirty-five per cent of patients had their operation within 36 hours from presentation. LESSONS LEARNT: The time to surgery for most transfer and direct presentation patients fell outside current guidelines. In our geographically large referral network, delay to surgery was significantly influenced by time to transfer. Based on previously published research, surgery for our hip fracture patients should be expedited. We therefore recommend priority transfer for these significantly injured patients and dedicated emergency operating lists to perform this surgery in a timely manner.