Introducing the principles of Enhanced Recovery to a fractured neck of femur pathway 5 years results and experience

Introduction There is great potential for the principles of Enhanced Recovery to be successfully applied to fractured neck of femur (FNOF) pathways and help to improve clinical outcomes. Aim To present the 5-year results and experience from Poole Hospital of applying the principles of Enhanced Recovery to FNOF patients. Method A mixed-methods sequential explanatory design (QUAN emphasised) that consists of quantitative followed by qualitative data collected to evaluate the project. Quantitative outcome data were extracted from Hospital Episode Statistics for 2008/09 to 2013/14 and analysed using a relative risk methodology. Relative Risk is the ratio of the observed number of outcomes to the expected number of outcomes and is case-mix adjusted. The NHS England average is calculated and 95% confidence intervals are applied to determine statistical difference from unit performance to the equivalent case-mix. Qualitative data were collected via staff interviews. Results A mean length of stay (LOS) of 12.3 days, a mortality rate of 5.7%, a 28-day re-admission rate of 10.2%, and a discharge home rate of 55% achieved in the last year of the project are lower than expected for hospital case-mix Staff interviews highlighted that key factors for success were: 1.Collaborative practice across all teams 2.Input from the Department of Medicine for the Elderly 3.Changing the pre-operative mindset whereby instead of having to prove patients are fit for surgery, they are assessed as fit for surgery unless proven otherwise. Conclusions Enhanced Recovery can be successfully applied to FNOF patients in order to improve patient outcomes. However, implementation may be more challenging and take longer than for elective orthopaedic procedures.