Optimising Neck of Femur Fractures Surgical Timing for Improved Patient Outcomes: An excellence of service Clinical Audit

Background: Hip fractures represent a significant global health burden, leading to substantial morbidity, mortality, and healthcare costs. Delays in surgical intervention are consistently linked to poorer patient outcomes. This audit aimed to evaluate and enhance hip fracture management at Southampton General Hospital (SGH) through targeted quality improvement initiatives.

Methods: An interventional clinical audit was conducted at SGH, a Major Trauma Centre, comparing a pre-intervention period (December 2023 – March 2024; n=272 patients) with a post-intervention period (September 2024 – December 2024; n=291 patients). The methodology adhered to NICE guidelines. Data were collected via consecutive sampling from the National Hip Fracture Database (NHFD), Pathpoint eTrauma, and CHARTS/EDMS. Interventions focused on increasing surgical capacity (e.g., additional theatre allocation, dedicated hip fracture team), implementing comprehensive multidisciplinary medical evaluation, optimizing imaging, addressing pre-existing conditions, standardizing anticoagulation reversal, and improving overall patient care. Mean operating times, 30-day mortality rates, and length of hospital stay (LOS) were assessed and compared between cycles.

Results: The overall average patient age was 84 years. In the pre-intervention cycle, the mean operating time was 80 hours, with a 30-day mortality rate of 4.7%. Surgical delays affected 57.4% of patients. Post-intervention, the mean operating time significantly decreased to 55 hours, and the 30-day mortality rate reduced to 3.0%, notably lower than the national average of 5.9% for the same period. Despite these improvements, the proportion of delayed surgeries increased slightly to 63.9%. A key finding was that in the post-intervention cycle, an equal number of patients (n=6) died in both the non-delayed (5.7%) and delayed (3.2%) groups, suggesting that enhanced medical optimization during delays contributed to improved outcomes. Delays consistently correlated with prolonged LOS in both cycles.

Conclusion: Targeted quality improvement initiatives at SGH significantly reduced the average time to hip fracture surgery and improved overall mortality rates. The crucial role of comprehensive medical stabilization in mitigating mortality risks, even when leading to surgical delays, was evident. Despite systemic challenges inherent to a major trauma center, these interventions demonstrate a positive impact on patient outcomes. Ongoing efforts should focus on sustainable theatre capacity, streamlined diagnostic pathways, and continuous auditing to optimize patient care.