Improving the Patient Journey for Hip Fracture Patients from Arrival in the Emergency Department to Admission to the Orthopaedic Ward

This Quality Improvement (QI) Project focuses on the admission pathway of hip fracture patients in a large acute hospital in Dublin. Hip fractures are the most common fragility fracture in the over 50’s in Ireland, accounting for 36.5% of orthopaedic admissions and 46.7% of orthopaedic bed days (Kelly et al 2018). It is a common injury but its effects on patients and carers is often underestimated by clinical staff (Saletti-Cuesta et al 2018)The National Office of Clinical Audit (NOCA) established an Irish Hip Fracture Database (IHFD) in 2012 to specifically audit and review hip fracture in Ireland with a view to improving patient care and morbidity as well as easing the burden on the healthcare system. The establishment of the IHFD has been in line with other European countries who have seen the rise of hip fracture patients presenting to the Emergency Departments. The IHFD founded six core standards to improve patient care and improve mortality. The first standard is the admission of the patient to the orthopaedic ward within four hours of presentation. This is a challenging standard, with current Emergency Departments in Ireland facing some of the worst overcrowding ever seen (Liston et al 2017), staff shortages as doctors emigrate to take up positions in other countries (Clarke et al 2017). The aim of this QIP is to improve patient flow from arrival in the ED through to admission within the 4 hour standard. The Quality Improvement (QI) tool DMAIC (Define, Measure, Analyse, Improve and Control) will be used to define the problem. A process flow map will be used to review the patient journey and review for any reasons for delays.