All hip fracture patients should be operated on within 48 hours of admission to minimise the risk of complications occuring while in hospital, latest UK guidance states.
Hip patients at one in five hospitals often waited longer than two days before procedures, risking complications such as pressure sores and pneumonia, according to the authors of the guidance published in the journal Anaesthesia.
A group of organisations including the Association of Anaesthetists of Great Britain and Ireland and the British Orthopaedic Association have drawn up a 10-point plan for the management of proximal femoral fractures.
In addition to “fast-tracking” care of hip fracture patients, the guideline recommendations include early mobilisation and taking steps to reduce the likelihood of future falls.
They also stress the importance of using a multi-disciplinary approach to caring for this patient group, with good communication between team members.
The authors said following their guidelines would ensure consistency in the management of the 77,000 patients who suffer hip fractures every year in the UK.
Guideline working party chair Richard Griffiths, a consultant anaesthetist, said: “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.”
Dr Griffiths added: “Unlike existing guidelines, [these guidelines] review the current clinical evidence and also recommend best practice in numerous circumstances where evidence is controversial or incomplete, based on expert consensus.
“These are the first guidelines to cover some of the difficult clinical problems faced by anaesthetists on a daily basis,” he said.
The 10-point action plan advises that:
- There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department
- Patients with hip fractures require multi-disciplinary care, led by orthogeriatricians
- Surgery is the best analgesic for hip fractures
- Surgical repair of hip fractures should occur within 48 hours of hospital admission
- Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists
- There must be high-quality communication between clinicians and allied health professionals
- Early mobilisation is a key part of the management of patients with hip fractures
- Pre-operative management should take into consideration plans for the patient’s discharge from hospital
- Measures should be taken to prevent secondary falls
- Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture