Enhanced recovery in patients who have had hip fracture
Whipps Cross Hospital is taking significant steps to enhance recovery outcomes for patients undergoing hip fracture surgery. It is estimated that 1 in 4 of us will unexpectedly break or fracture our hip. In 2023, the hospital performed 556 hip fracture surgeries, but only 57% of patients reported optimum outcomes in line with several measures including development of pressure ulcers, mobilisation after surgery, experience of delirium and length of hospital stay. Recognising the need for improvement, especially for complex medical patients with comorbidities such as obesity, the hospital, has introduced the Enhanced Recovery After Surgery (ERAS) protocol in its orthopaedics department.
ERAS is an evidence-based approach that targets all three phases of patient care:
1. Before Surgery: This phase includes patient assessment, counselling, avoiding premedication, ensuring proper nutrition and timely surgery (<36hrs).
2. During Surgery: The focus is on minimally invasive techniques, regional anaesthesia, and standardised anaesthetic protocols.
3. After Surgery: Key interventions involve early mobilisation, nutrition, and effective pain relief. The ERAS-DrEaMing component, which emphasises drinking, eating, and mobilising within 24 hours post-surgery, is crucial at this stage.
Studies have consistently shown that ERAS significantly reduces complications for patients receiving this standard of care. Once fully ERAS is fully established, we expect to see a reduction in hospital stays and improves outcomes more generally compared to patients who did not achieve early post-surgery mobilisation.
Dr Amanjit Jhund, Chief Executive at Whipps Cross, highlighted the importance of this initiative, saying, "our commitment to adopting the ERAS protocol underscores our dedication to providing the highest quality care for our patients. By facilitating quicker recovery and reducing the time patients spend in hospital and help our patients return to their normal lives sooner, which is integral to better long-term outcomes."
Whipps Cross is the first hospital within Barts Health to introduce the ERAS protocol in patients undergoing neck of femur (NOF) fracture repair and we expect to see an increase in the rate of patients receiving the best standard of care to 85% in the short term.
Dr Judith Agwada-Akeru, Clinical Lead for Orthogeriatrics, expressed optimism about the new protocol's impact: "The implementation of ERAS in NOF fracture at Whipps Cross is a significant advancement in our orthopaedic care. We anticipate not only improved recovery times but also a substantial decrease in post-surgical complications, ultimately leading to enhanced patient satisfaction and overall health outcomes."
The launch of ERAS at Whipps Cross marks a pivotal moment in the hospital’s ongoing efforts to improve patient care standards and outcomes, particularly for those undergoing unplanned surgeries.
The Multi-Disciplinary Team (MDT) have been closely supported by Johnson & Johnson MedTech’s Services & Solutions Team in the delivery of the Fractured NOF Pathway Project. J&J MedTech provided dedicated project and change management experts and resources to drive the required deliverables at pace, whilst providing infrastructure to ensure long-term, sustainable change that supports optimal patient outcomes and increased efficiency of care.
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