Navigation Links
Hip fracture guidelines tackle 'considerable variations' in UK and Irish hospital care
Date:1/11/2012

All patients with hip fractures should be fast-tracked through hospital emergency departments and operated on within 48 hours of admission, according to new consensus guidelines developed by UK experts in anaesthesia, orthopaedics, geriatrics and emergency medicine and published in the January issue of Anaesthesia.

However, patients in one in five hospitals in England and Wales currently wait longer than two days, risking lengthier inpatient stays, increased health problems - such as pressure sores, pneumonia and blood clots - and even an increased chance of death if the delay is prolonged.

The Association of Anaesthetists of Great Britain and Ireland teamed up with a number of other organisations, including the Age Anaesthesia Association and British Orthopaedic Association, to develop the new ten-point plan for the Management of Proximal Femoral Fractures.

"Unlike existing guidelines, they review the current clinical evidence and also recommend best practice in numerous circumstances where evidence is controversial or incomplete, based on expert consensus" says consultant anaesthetist Dr Richard Griffiths, who chaired the working party.

"These are the first guidelines to cover some of the difficult clinical problems faced by anaesthetists on a daily basis.

"For example, we recommend that if any investigations need to be carried out on patients with systolic heart murmurs, this should be done as a matter of urgency to avoid delaying their operations.

"The management of patients on antiplatelet drugs to avoid blood clots forming is another controversial area. Evidence is incomplete, but the expert consensus is to proceed with surgery without stopping the drugs, as operating delays pose a greater risk to the patient."

Hip fractures present unique challenges for anaesthetists as they often occur in elderly patients with significant health problems, stresses Dr Griffiths.

"Despite the fact that guidance has been in place since the early 1990s concerning best practice management for these vulnerable patients, there remain considerable variations in models of post-operative care, rehabilitation and orthogeriatric input" he says.

"Bringing together experts in anaesthesia, orthopaedics, geriatrics and emergency medicine has enabled us to look at the journey of the hip fracture patients from admission to discharge and recommend how their care can be maximised by everyone involved."

Approximately 77,000 patients break their hips in the UK every year, spending an average of 16 days in hospital and costing the National Health Service 785 million. The majority (95 per cent) occur in people over 60 years of age and 75 per cent occur in females.

More than eight per cent of patients will die within 30 days of a hip fracture, especially if they are older, sicker or male, and this figure rises to up to 30 per cent within a year. It has been suggested that half of postoperative deaths are potentially preventable.

Only 44 per cent of UK patients admitted from home are discharged back to their home within 30 days of surgery. A further 22 per cent are discharged to a residential or nursing home and they can often spend a long time in hospital waiting for admission to these facilities, blocking much needed beds.

The ten-point action plan advises that:

  1. There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department.
  2. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians.
  3. Surgery is the best analgesic for hip fractures.
  4. Surgical repair of hip fractures should occur within 48 hours of hospital admission.
  5. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists.
  6. There must be high-quality communication between clinicians and allied health professionals.
  7. Early mobilisation is a key part of the management of patients with hip fractures.
  8. Pre-operative management should take into consideration plans for the patient's discharge from hospital.
  9. Measures should be taken to prevent secondary falls.
  10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

"We hope that our guidelines will address current variations in clinical practice so that patients can all benefit from a more consistent approach" concludes Dr Griffiths, who is also lead clinician for the National Health Service Hip Fracture Perioperative Group, an initiative started by anaesthetists, but with increasing membership from orthogeriatricians.


'/>"/>

Contact: Annette Whibley
annette.wizard@gmail.com
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. AAOS issues new clinical practice guideline for treating common elbow fractures in children
2. Hip Fracture May Raise a Womans Risk of Earlier Death
3. Study: Long-term inhaled corticosteroid use increases fracture risk in lung disease patients
4. Treatment gap leaves many older adults at unnecessary risk of fracture
5. Bariatric surgery linked to increased fracture risk
6. Weight-Loss Surgery Linked to Rise in Fracture Risk
7. Could a Womans Wrinkles Predict Risk of Fractures?
8. New version of WHO Fracture Risk Assessment Tool (FRAX) launched
9. Breaking the fracture cycle through effective and coordinated models of care
10. Popular Heartburn Meds May Boost Fracture Risk
11. Study Finds Slight Risk of Rare Fractures From Bone Drugs
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... June 25, 2016 , ... Experts from the American ... Annual Research Meeting June 26-28, 2016, at the Hynes Convention Center in Boston. ... including advance care planning, healthcare costs and patient and family engagement. , AIR ...
(Date:6/25/2016)... ... ... "With 30 hand-drawn hand gesture animations, FCPX users can easily customize each ... Film Studios. , ProHand Cartoon’s package transforms over 1,300 hand-drawn pictures into hand ... select a ProHand generator and drag it above media or text in the Final ...
(Date:6/25/2016)... Oklahoma City, Oklahoma (PRWEB) , ... June 25, ... ... to helping both athletes and non-athletes recover from injury. Recently, he has implemented ... for the Oklahoma City area —Johnson is one of the first doctors to ...
(Date:6/24/2016)... ... June 24, 2016 , ... A recent article ... people are unfamiliar with. The article goes on to state that individuals are now ... of these less common operations such as calf and cheek reduction. The Los Angeles ...
(Date:6/24/2016)... ... ... in a crisis. Her son James, eight, was out of control. Prone to extreme mood ... something upset him, he couldn’t control his emotions,” remembers Marcy. “If there was a ... children and say he was going to kill them. If we were driving on ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Research and Markets has ... 52" report to their offering. ... creates a favourable commercial environment for MedImmune to enter. The ... that will serve to drive considerable growth for effective anti-influenza ... to cap sales considerably, but development is still in its ...
(Date:6/23/2016)... Calif. , June 23, 2016 ... CST on Thursday, July 7, 2016 , , , , ... ) , , , , EXPERT PANELISTS:  , , ... Naik; Senior Industry Analyst, Christi Bird; Senior Industry Analyst, Divyaa Ravishankar ... The global pharmaceutical industry is witnessing an exceptional ...
(Date:6/23/2016)...  Astellas today announced the establishment of Astellas Farma Colombia (AFC), a new affiliate with operations headquartered in ... . ... ... ... Astellas ...
Breaking Medicine Technology: