Abstract
Introduction: Older adults with neck of femur (NOF) fractures often fast for prolonged periods, increasing dehydration, delirium risk and peri-operative morbidity. At Chesterfield Royal Hospital, ortho-geriatric department, we implemented Sip Til Send with 150-ml per hour of water Sip Til Send (S2S) pathway and evaluated feasibility, process and safety.
Methods Control: subset was taken from 01/03/25-05/05/25. Following this prospective data was collected for all NOF patients put on the S2S pathway from 06/05/25-10/08/25; local contraindications were excluded.
Outcomes: Age, American Society of Anesthesiologists (ASA) grade, 4 ‘A’s Test (4AT) pre/post, antiemetic use postoperatively, length of stay (LOS), aspiration. Cycles: C1 ward-nurse education with 150-ml beakers and charting (from 06/05/2025); C2 multidisciplinary cascade (from 23/06/2025). Results Baseline (Mar–Apr) n=95: median age 82 years; LOS 11 days; ASA≥3 68/93 (73.1%); 4AT positive (≥4) pre-op 20/94 (21.3%), post-op 19/95 (20.0%); antiemetics 31/95 (32.6%); aspiration 0/95. Post-implementation (06/05–10/08) n=93: LOS 9 days; 4AT positive pre-op 19/89 (21.3%), post-op 20/90 (22.2%); antiemetics 22/92 (23.9%); aspiration 0/93. Education/process: C1 survey (n=25) confidence 3.6→4.8/5; correct 150-ml limit 23/25; water-only 20/25. C2 feedback (n=12) confidence 2.2→4.9/5; 150-ml 12/12; water-only 10/12; mapping barriers 8/12 → C3 door-maps.
Conclusion: The S2S pathway improves comfort, patient experience and reduces peri-operative morbidity in a medically burdened orthogeriatric NOF population without compromising safety. Positive early results are informing planned roll-out across wider surgical services at Chesterfield.
Comments
This is great and our local…
This is great and our local district hospital has adopted the SipTilSend pathway for our hip fracture patients and it has seen positive results. From a therapy perspective providing rehab post operatively for this population group; it does make a difference specifically in our elderly population.
Thank you for your comment!…
Thank you for your comment! It's great to see S2S making positive headlines elsewhere. It's crazy to see there is still pushback despite postive results in many different places and areas.
I agree with SipTilSend helps in hip fracture care
As an orthogeriatrics ACP I look into this process as well in our hip fracture ward. Even though we only have 1 ward, it was a struggle sometimes since some anaesthetists were still not aware of it despite the campaign about it when we started. We have educated our nursing staff regarding this. Your poster only proves that there is benefit with this even though it is just about 10% reduction of anti-emetic usage and 1 day reduction in LOS, it is still reduction with cost-saving benefits and this benefits patients as well. Well done to you!
Thank you so much! The works…
Thank you so much! The works isn't done, we are still looking into reduction in starvation times and hopefully seeing if we can incorporate a carbohydrate drink in the pre-op protocol. Hopefully soon S2S will be widely used and we won't have to worry about educating all different personnel in the near future!