Aims: We explored the existing provision of care to patients with hip fracture, and barriers and facilitators of best care, across NSW.
Methods: We performed a cross-sectional survey of all hospitals in New South Wales (NSW), Australia, providing care to patients with acute hip fracture.
Results: Amongst 30/36 (83% response rate) hospitals, with representation from all 15 local health districts, 9/30 did not have a formal orthopedic surgery/geriatric medicine shared care model; of those that did (N=21), the commonest was orthopaedic surgery admission with routine (ortho)geriatrician input. Respondents identified multiple barriers to optimal hip fracture care, along most stages of the guideline-recommended care pathway. In the emergency department, lack of staffing and inadequate service structures were perceived to contribute strongly to suboptimal care. Competing clinical priorities and lack of knowledge/education were common contributors to delirium (mis)management. Lack of specialist staff (due to geography or otherwise), impacted at several stages of the patient’s journey. Barriers to bone protection were manifold. Multidisciplinary meetings were felt to promote team communication, but absence of relevant team members was an impediment. Barriers to transfer of care included lack of residential aged care beds and stringent criteria for rehabilitation units. Reported enablers of good practice included: clear escalation and hand-over processes, multidisciplinary communication strategies, and guideline-aligned clinical pathways, amongst others.
Conclusions: This state-wide survey revealed wide variation in delivery of hip fracture care from admission to discharge, and specific points for intervention. Support and investment are needed to effectively implement change, but is likely to translate into real patient benefits.