ABSTRACT
INTRODUCTION: The National Institute for Health and Care Excellence (NICE) updated the 2011 hip fracture management guidelines on January 6, 2023, suggesting that clinicians offer sliding hip screws in preference to intramedullary nails for trochanteric fractures above and including the lesser trochanter except reverse oblique fractures. This study aims to assess the compliance of our hospital with the updated guidelines while comparing the results with our performance prior to the update together with the national average. MATERIALS AND METHODS: A retrospective observational study was done to analyse if trochanteric fractures managed surgically were compliant with NICE guidelines. Pathological fractures secondary to tumours and AO/OTA 31A1.1 fractures were excluded. Fractures were classified using the 2018 AO/OTA classification system independently by two authors, with a review from a senior consultant if there was interobserver variation. Group A (n=60) included trochanteric fractures managed surgically three months prior to the update, while Group B (n=46) included patients managed operatively three months following the update. RESULTS: The compliance rates for Group A and Group B were similar at 88.33% and 89.13%, respectively, while the national average was about 67% over the course of six months. DISCUSSION: 31A2 fractures showed higher rates of non-compliance in both groups. Non-compliance was thought to be multifactorial: surgeon bias, inaccurate classification of fractures and a lack of awareness of guidelines. CONCLUSIONS: While there is scope for improvement, district general hospitals can achieve high rates of compliance. Educating and training doctors could help improve compliance.
ABSTRACT
Background The Trauma and Orthopaedic (T&O) on-call service receives referrals from the emergency department (ED), general practice (GP) and urgent treatment centres (UTCs) and requests for inpatient reviews. The virtual fracture clinic (VFC) pathway allows ED and UTC clinicians to assess, discharge and refer when necessary. For VFC, the on-call orthopaedic consultant reviews the cases the next working day and makes an appropriate plan. This pathway consists of a traffic light system, in which practitioners can either safely discharge with written advice (green), refer to the VFC (yellow) or refer to the on-call team (red). Method The aim of this study was to assess how the VFC pathway was being utilised. All referrals to the T&O on-call team over three weeks were evaluated retrospectively. The following referrals were excluded: fractured femur, head injury, trauma calls and back pain pathway. The following data were collected: patient details, diagnosis, referral source, reason for referral, plan, double booking with VFC and appropriateness. Results A total of 191 referrals were analysed. Most referrals are from the ED (51%) and UTC (23%). Of the referrals, 39% were deemed to be inappropriate. Of the inappropriate referrals, 35% should have been referred directly to the VFC rather than the on-call team. A significant minority (7%) of inappropriate referrals were referred to the on-call team and VFC. Conclusion Education and collaboration are required with the ED and UTC to ensure the proper use of the VFC pathway. Immediate radiograph reporting may also be beneficial.
ABSTRACT
Health care management and leadership education is an important gap in the undergraduate medical curriculum. Lack of training promotes poor decision making and may lead to inadequate health services, adversely affecting patients. We propose an integrated approach to health care management and leadership education at undergraduate level, to enable doctors to be effective leaders and manage resources appropriately and to ultimately improve patient care.