Abstract
Introduction
The National Hip Fracture Database (NHFD) 2023 report recommended a care bundle for patients leaving theatre recovery to include anaesthetists’ postoperative instructions regarding blood pressure, fluid management, transfusion and postoperative pain to improve outcomes. This audit evaluates our effectiveness in adhering to these recommendations.
Methods
We retrospectively audited the case notes of 51 hip fracture patients undergoing surgery between June and September 2024 in our trauma centre.
Results
76.5% of patients were >80 years, 27.5% were ASA grade 4. One of the 51 patients died within 30 days of surgery.
Weekend surgery resulted in fewer day 0 routine postoperative reviews by ward doctors than weekdays (53.8% vs. 73.6%). 49% of patients developed inpatient fluid imbalance. Urine output, blood pressure and intravenous fluid prescribed in theatre was documented in only 80%, 84.3% and 68.6% of cases, respectively. Urine output and blood pressure documented by ward doctors was 56.9% and 70.6%.
Only 1/33 patients whose postoperative haemoglobin was checked in recovery required blood transfusion on day one compared to 3/18 patients where it was not checked. Of the four patients with a day one postoperative haemoglobin <90 only one had a haemoglobin documented in recovery.
4AT scores of ≥4 implying delirium were seen in 21.6% preoperatively and 19.6% postoperatively.
86% had a fascia-iliac block in theatre. 86% mobilised on day one (75% NHFD average). 2% were unable to mobilise due to hypotension (3% NHFD average) and 2% due to pain (3% NHFD average).
Conclusions
This audit used a structured approach to identify areas for improvement; the documentation of urine output and postoperative haemoglobin in recovery to guide resident ward doctors and improving day 0 routine postoperative review.
This audit emphasises the need for adhering to “ready to leave recovery” care bundle to reduce delirium and aid early mobilisation.