Piloting 'Sip Til Send' in Orthogeriatric Patients with Neck of Femur Fracture: QI Project, Homerton Hospital, London

Introduction   
Neck of femur fractures (NOFF) account for ~72,000 UK admissions annually, affecting frail, comorbid older adults. Unpredictable trauma scheduling prolongs fasting, worsening starvation, dehydration and delirium risk. 'Sip Til Send' (STS) permits clear fluid sips until surgery, advocated nationally for hip fracture and internationally for surgery. We aimed to implement and evaluate an STS protocol (up to 170 ml/hour) for NOFF patients on an orthogeriatric pathway at Homerton Hospital, London.   

Methods   
We retrospectively audited NOFF patients undergoing operative management. Audit cycle 1 (February–March 2026) collected data on demographics, protocol documentation, perioperative timings (time of last oral intake), and outcomes: AKI, post-operative nausea and vomiting (PONV), hospital-acquired pneumonia, mortality. Following presentation to orthopaedic governance and approval by trauma anaesthetics in May 2026, STS was disseminated to acute department leads and incorporated into the NOFF clerking proforma. Cycle 2 re-audit was undertaken for patients admitted June–July 2026 to evaluate impact.   

Preliminary results   
Cycle 1 (n=20; median age 79.5; 9 male) and cycle 2 (n=10; median age 83; 2 male) were comparable. STS documentation rose from 7/20 (35%) to 5/10 (50%). Less observed post-operative delirium from 9/20 (45%) to 3/10 (30%). Observed PONV rose slightly, 1 to 2 cases (5% to 20%). Post-operative pneumonia fell from 5/20 (25%) to 1/10 (10%), and AKI was similar (2/20, 10% vs 1/10, 10%). There was 1 inpatient death in cycle 1, none in cycle 2, and no aspiration events in either cycle.   

Conclusion   
Embedding STS within the NOFF clerking proforma increased protocol uptake. STS was safe and well-tolerated, with no aspiration events and showed less observed post-operative delirium and pneumonia, though PONV was unchanged. Mortality was low overall, with 1 death pre-intervention. Next steps include an educational programme for medical and nursing staff in acute departments emphasising the importance of implementation and documentation of STS.