1956 Audit on the prompt mobilisation of patients following hip arthroplasty
B Hama, A Illsley- Geriatrics and Gerontology
- Aging
- General Medicine
Abstract
Background
Hip fractures are fractures involving the femoral head, neck or proximal shaft. They most often occur in frail, osteoporotic elderly patients following falls. Hip fractures are associated with a 30-day mortality rate of 10% and a 1-year mortality rate of approximately 30%. NICE and NHFD advise prompt mobilisation post-surgery - with patients being mobilised by the day after surgery at the latest: 1. Nice Guidelines Hip Fracture in Adults; Quality statement 6: Rehabilitation after surgery 2. NHFD KPI 4 – prompt mobilisation after surgery
Method
We carried out two audit cycles assessing the mobilisation rate of patients by the day after hip arthroplasty, at Bradford Royal Infirmary. In the first cycle, from 23 eligible patients, we found only 15 (65%) were mobilised within a day of surgery.
Results
These patients had a reduced length of stay compared to the patients not mobilised by the day after surgery (15.1 vs 18.1 days). As per our data, the reasons for delayed mobilisation included 1. pain (suggest early and regular analgesia), and 2. system miss (discussed with local physiotherapy team). After four months we reaudited. Of 23 eligible patients we found an improvement in patients being mobilised - 17 patients (74%) were mobilised within a day of surgery. Once again length of stay was less in the patients who had been mobilised (21.2 vs 29.7 days). Similar reasons for delayed mobilisation remained.
Conclusion
Our interventions improved the promptness of mobilisation in patients who had undergone hip arthroplasty. This led to a reduced duration of inpatient stay and better patient outcomes. Audit limitations included population size.