What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Proximal femoral fracture remains the commonest cause of orthopaedic admission in UK, accounting for 75000 cases annually. Financial burden aside, proximal femoral fractures especially in the elderly age group are associated with increased morbidity, mortality and loss of independence. Despite predominantly successful surgical outcome with contemporary surgical techniques, proximal femoral fixation procedure remains to be plagued by the associated risk of implant failures. Revision surgery is often accompanied by higher surgical complications, thereby increasing the morbidity and mortality.

We aim to minimise the complications associated with the surgical management of this cohort by developing a pre-operative risk assessment tool to pre-empt any potential complications. Closely working with anaesthetists, physicians, physiotherapists, primary care teams and social care to facilitate a smooth hospital journey and discharge to the community to prevent bed blocking and readmission.

What does your project aim to achieve?

Despite predominantly successful surgical outcome with contemporary surgical techniques, NOF fixation procedure remains to be plagued by associated risk of implant failures. Effective strategies are required to improve outcomes.

Overall-objectives:

• Improved patient experience & safety
• Improve surgical outcomes
• Reduced complications/re-operations
• Improved directed care pathways during hospital stay & after discharge in the community

How will the project be delivered?

A retrospective analysis of NOF patients who required surgical revision/reoperation at on of the three acute trusts in the Norfolk and Waveney ICS (James Paget University Hospitals, Norfolk and Norwich University Hospital and Queen Elizabeth Hospital) over 5years will be conducted, to analyse causes & identifying the non-modifiable & modifiable factors, e.g. patient demographics, technical/surgical factors & implant choice associated with re-operations

Stage 1

To determine the causes of Re-Operations & identify any subgroups with increased risk if there is a relationship between the type of fracture, bone quality, surgical implant used & risk of Re-operation.

Stage 2

Develop:

• a risk-assessment-tool, providing recommendations to improvise the surgical & technical factors to minimize Re-operations.
• an e-learning package, in collaboration physiotherapy team, for community teams, to facilitate earlier, safer discharges, reducing bed-blocking in hospitals and reduce readmissions.

How is your project going to share learning?

The results of our risk stratification will be shared nationally with societies and the community services.

They will also be shared through the Q community, professional networks, conferences and on social media.

Write up of finding and development of risk assessment tool for submission to a suitable peer-review journal (e.g. BMJ Open Quality).