Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lee LKK(1)
Affiliation :
(1) Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
With the ageing of the population in our locality, it is expected to have an increased demand for Geriatric hip fracture surgery. At the same time, these patients commonly have multiple comorbidities which will add further challenges to the perioperative anaesthetic care. The international guidelines recommend prompt surgical intervention for hip fractures. However, there are instances where early surgery may not be suitable, due to various reasons.
Objectives :
The objectives are to (1) explore the incidence of cancellations for hip fracture surgeries and (2) identify the reasons for these cancellations, aiming for improvement in patient care.
Methodology :
A retrospective audit was performed. All fractured neck of femur booked in emergency/ trauma list from June 2022 to December 2022 were identified from the hospital OT booking system (OTMS). Further analysis was done to determine the cause of cancellations. Also, the 6 month all-cause mortality after hip fracture surgery was determined from CMS records.
Result & Outcome :
From June to December 2022, a total of 305 emergency/trauma list surgeries were booked for hip fractures. 30 of these cases were cancelled with various reasons. Cancellation rate is 9.8%. Delays resulted from cancellation ranged from 1 to 9 days, with the majority experiencing delays of 1-2 days. Causes identified include lengthy waitlists (50%), medical issues (33%), elective rescheduling (7%), instrument unavailability (7%), and patient refusals (3%). A 6-month all-cause mortality rate of 9.5% was recorded for all included cases.
Hip fractures are common in our locality. The aging population and growing emergency cases strain existing resources, requiring better utilization of operating theatres for timely surgeries. The key to safely and efficiently managing these cases requires prompt medical assessment of the patients and multidisciplinary collaboration among physicians, anaesthetists, and orthopaedic surgeons to facilitate early surgery. Expand of designated service for hip fracture surgeries should be considered with the high percentage of cancellation due to lengthy waitlist. Further optimization of the utilization of operating theatres is of prime importance.
