Implementation evaluation of an early notification care bundle for patients with hip fracture (eHIP).

BACKGROUND: Hip fracture in older adults results in significant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group however uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes.

METHODS: This controlled pre-and post-test study was conducted from June 2019 - June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs.

RESULTS: There were 565 cases included for analysis. After implementation of eHIP (the post-period) 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presentation (pain and cognitive assessment) increased by 23% and unrestricted mobilisation within 24h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2% to 57%) and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change.

CONCLUSION: eHIP, a hip fracture care program incorporating evidence-based behaviour change theory resulted in sustained improvements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.