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Coeckelberghs E, Vanhaecht K, Akiki A, Castillón P, Cox B, Attal RE, Foss NB, Frihagen F, Gerich TG, Kanakaris NK, Kristensen MT, Mohaddes M, Panella M, Pape HC, Sermon A, Seys D, Nijs S. Variation in care and outcome for fragile hip fracture patients: a European multicentre study benchmarking fulfilment of established quality indicators. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02549-0. [PMID: 38819678 DOI: 10.1007/s00068-024-02549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. METHODS This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. RESULTS A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). CONCLUSION The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.
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Affiliation(s)
- E Coeckelberghs
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium.
- European Pathway Association, Leuven, Belgium.
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
- European Pathway Association, Leuven, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, Belgium
| | - A Akiki
- Hôpital Riviera Chablais, Rennaz, Switzerland
| | - P Castillón
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - B Cox
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | - R El Attal
- Klinik für Orthopädie und Unfallchirurgie, Sporttraumatologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - N B Foss
- Departments of Anaesthesia and Intensive Care, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
- Denmark Institute for clinical medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Frihagen
- Orthopedic Department, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T G Gerich
- Head of orthopaedic trauma, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - N K Kanakaris
- Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - M T Kristensen
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - M Panella
- European Pathway Association, Leuven, Belgium
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - H C Pape
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Zurich, Switzerland
| | - A Sermon
- Traumatology Department at University Hospitals Leuven, Leuven, Belgium
| | - D Seys
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | - S Nijs
- Traumatology Department at University Hospitals Leuven, Leuven, Belgium
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2
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Rougereau G, Naline C, Boisrenoult P, Langlais T, Pujol N. Proximal femoral fracture and female gender are risk factors for recurrent fracture: Cohort study of 292 patients over 75 years-old with iterative osteoporotic fractures. Injury 2023:S0020-1383(23)00187-0. [PMID: 36931968 DOI: 10.1016/j.injury.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The purpose of this study was to: 1/ describe the characteristics of a cohort of patients over 75 years of age hospitalized in perioperative geriatric units (UPOG) for iterative fractures; 2/ investigate the risks of institutionalization related to the first fracture; and 3/ search for potential risk factors for iterative fracture. METHODS This is a retrospective single-center study analyzing patients over 75 years old, hospitalized in UPOG. RESULTS Of the 3207 patients hospitalized, 292 patients had a refracture (9.1%), with a mean age of 85.4+/-5.8 years. Initial fractures were mainly intertrochanteric (43.2%) and the femoral neck (32.9%). Refractures occurred mainly in the first year (55.5%), with a median delay of 9.6 months. Refractures were mainly intertrochanteric (29.5%), peri‑implant (prosthesis, osteosynthesis) (28.8%), and femoral neck (26.7%). Dementia was the only factor for institutionalization after the first fracture episode (p = 0.0002). Proximal femoral fracture (PFF) and female gender were risk factors for iterative fracture (10.2% vs. 6.8%, p = 0.003; 10.7% vs. 6.8%, p = 0.005 respectively), but not age (85.4 vs. 85.8 years, p = 0.24). PFF were more likely to result in the same fracture type in the second episode (58.1% vs 7.1%, p<0.0001). The time to refracture was shorter in case of peri‑implant fracture (p = 0.0002), or discharge directly to home (p = 0.04). CONCLUSION PFF and female gender are risk factors for recurrent fracture, which is even more likely to occur early in case of home discharge or peri‑implant fracture.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - Charlotte Naline
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France; Department of Geriatrics, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Philippe Boisrenoult
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Department of Orthopaedic paediatric Surgery, Hôpital des enfants, Purpan, Université de Toulouse, Toulouse, France; Department of Orthopaedic paediatric Surgery, Sorbonne Université, A. Trousseau, APHP, Paris, France
| | - Nicolas Pujol
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
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Sermon A, Slock C, Coeckelberghs E, Seys D, Panella M, Bruyneel L, Nijs S, Akiki A, Castillon P, Chipperfield A, El Attal R, Foss NB, Frihagen F, Gerich TG, Gümbel D, Kanakaris N, Kristensen MT, Malchau I, Palm H, Pape HC, Vanhaecht K. Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus. Arch Osteoporos 2021; 16:152. [PMID: 34625842 DOI: 10.1007/s11657-021-00995-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.
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Affiliation(s)
- An Sermon
- KU Leuven, Leuven, Belgium.,Traumatology Department at University Hospitals Leuven, Leuven, Belgium
| | | | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium.,European Pathway Association, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | - Massimiliano Panella
- European Pathway Association, Leuven, Belgium.,Università Degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | | | - Alain Akiki
- Hôpital Riviera Chablais, Rennaz, Switzerland
| | - Pablo Castillon
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.,Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - Alex Chipperfield
- Consultant Trauma and Orthopaedic Surgeon, East Kent Hospitals NHS Trust, Kent, UK
| | - René El Attal
- Klinik für Orthopädie und Unfallchirurgie, Sporttraumatologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Nicolai Bang Foss
- Departments of Anaesthesia and Intensive Care, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frede Frihagen
- Orthopaedic Department, Østfold Hospital Trust, Grålum, Norway.,Associate Professor, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torsten G Gerich
- Head of Orthopaedic Trauma, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolaos Kanakaris
- Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Morten Tange Kristensen
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Palm
- Head of Department, Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Bispebjerg, Denmark
| | - Hans-Christoph Pape
- Department of Trauma, University of Zurich, Universitäts Spital Zurich, Zurich, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium. .,European Pathway Association, Leuven, Belgium. .,Department of Quality, University Hospitals Leuven, Leuven, Belgium.
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Frandsen CF, Glassou EN, Stilling M, Hansen TB. Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients. Acta Orthop 2021; 92:544-550. [PMID: 33977861 PMCID: PMC8519558 DOI: 10.1080/17453674.2021.1925430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Following a hip fracture, most patients will encounter poorer functional outcomes and an increased risk of death. Treatment-monitoring of hip fracture patients is in many countries done by national audits. However, they do not allow for a deeper understanding of treatment limitations. We performed a local evaluation study to investigate adherence to 7 best-practice indicators, and to investigate patient groups at risk of suboptimal treatment.Patients and methods - 2,804 patients were surgically treated for a hip fracture from 2011 to 2017 at our institution. Data regarding admission, hospital stay, and discharge was prospectively collected, and adherence to the 7 best practice indicators (nerve block, surgical delay, antibiotics, implant choice, thromboprophylaxis, mobilization, and blood transfusions) was analyzed. Patient groups with lower adherence were identified.Results - 34% of patients received all 7 best practice indicators after considering contraindications; in particular, nerve blocks and thromboprophylaxis displayed low adherence at 61% and 91% respectively. Nursing home residents and patients with cognitive impairment, multiple comorbidities, or low functional levels were at risk of having a lower adherence.Interpretation - The most dependent patients with cognitive impairment, comorbidities, or low functional levels had lower guideline adherence. This large patient subgroup needs a higher treatment focus and more resources. Our findings are likely similar to those in other national and international institutions.
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Affiliation(s)
- Christina F Frandsen
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Regional Hospital West Jutland,Correspondence:
| | - Eva N Glassou
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Regional Hospital West Jutland,Department of Quality, Regional Hospital West Jutland
| | - Maiken Stilling
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Regional Hospital West Jutland,Department of Clinical Medicine, Aarhus University, Denmark
| | - Torben B Hansen
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Regional Hospital West Jutland,Department of Clinical Medicine, Aarhus University, Denmark
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Seys D, Coeckelberghs E, Sermeus W, Van Zelm R, Panella M, Babu Payedimarri A, Vanhaecht K. Overview on the target population and methods used in care pathway projects: A narrative review. Int J Clin Pract 2021; 75:e14565. [PMID: 34165865 DOI: 10.1111/ijcp.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is evidence that the efficiency and effectiveness of care processes can be improved in all countries. Care pathways (CPs) are proposed as a method to improve the quality of care by reducing variation. During the last decades, CPs have been intensively used in practice. The objective of this study is to examine the study designs for investigating CPs, for which pathologies CPs are used and what the reported indicators to measure the impact of CPs are. METHODS A narrative review of the literature published from 2015 to 2019 was performed. RESULTS We identified 286 studies, of which 207 evaluated the impact of CPs, 33 were review articles, 29 studies described the development of a CP, 12 were study protocols and 5 opinion papers. The most frequently reported study design for studying the impact of a CP is pre-posttest (n = 82), followed by cross-sectional studies (n = 50). Oncology, cardiovascular disease and abdominal surgery are the domains with the highest numbers of studies evaluating the impact of CPs. Financial (n = 86), process (n = 76) and clinical indicators (n = 74) are the most frequently reported indicators while service (n = 12) and team indicators (n = 6) are less reported. CONCLUSIONS Based on the relative low number of identified studies compared with the number of CP projects in organisations, we conclude that the CP knowledge is not only found in the literature. We, therefore, argue that (inter)national scientific societies should not only focus on searching and spreading evidence on the content of care but also enhance their knowledge sharing initiatives on the organisation of care processes.
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Affiliation(s)
- Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ruben Van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Anil Babu Payedimarri
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Boman E, Duvaland E, Gaarde K, Leary A, Fagerström L. Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies. J Adv Nurs 2020; 76:1069-1076. [DOI: 10.1111/jan.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | | | - Kim Gaarde
- Drammen Hospital Vestre Viken HF Drammen Norway
| | - Alison Leary
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- School of Health and Social Care London South Bank University London UK
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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7
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Smith S, Carlton E. Introducing quality improvement to the Emergency Medicine Journal. Emerg Med J 2019; 36:258-263. [PMID: 31015212 DOI: 10.1136/emermed-2019-208609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Simon Smith
- Emergency Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
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