000			03390cam a2200193 4500
001			NMDX7824
008			120401t2015 xxu||||| |||| 00| 0 eng d
100			_aHockridge, J.
240			_aAnaesthesia
245			_aThe effect of introducing a hip fracture bleep alert on time to patient review
260			_c2015
500			_aNMUH Staff Publications
500			_aEMBASE
500			_a70
520			_a<span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">Hip fracture is the most common reason a frail older patient will need anaesthesia and surgery [1]. Patients operated on within 48 h have better outcomes [2]. Poor control of comorbidities is often a cause of delayed surgery so early multidisciplinary involvement is desirable. In the last year our hospital experienced a huge increase in the number of patients presenting with hip fractures. A multidisciplinary hip fracture improvement group was formed to improve the overall care of these patients. One of the strategies introduced was a hip fracture bleep alert. This was triggered by the accident and emergency (A&E) department after triage. The respondents were from the orthopaedic, anaesthetic and medical teams. The aim of this audit was to assess if introducing the bleep alert had reduced the time to patient review by the different teams. We could not find any other report on introducing a hip fracture bleep alert in the literature to compare our results with. Methods We collected retrospective data from a similar time of the year - pre and post introduction of the bleep alert. We recorded response times of the relevant bleep holders. Response time was measured from the time of triage in A&E, which is always clearly documented, to time of review by the teams. A secondary outcome was time from triage to performance of a nerve block for analgesia. Results (table present). Discussion Following the introduction of a hip fracture bleep alert there was a statistically significant decrease in the response time of the first responder, the orthopaedic SHO (p = 0.013). The paradoxical increase in response time of the medical registrar can be explained by the fact that on weekdays there is now a dedicated ortho-geriatrician. The geriatrician does not carry a bleep but is phoned directly once a hip fracture patient presents in A&E. It is impossible to ascertain what effect the bleep alert had on anaesthetic response time due to poor documentation. However the improved documentation now provides a baseline which will be useful in the next audit cycle. Similarly the improved nerve block rate, due to other strategies such as in-house training in nerve block provision, is a working figure. In the pre bleep group 92% of patients had surgery compared to 95% in the post bleep group. Despite increased numbers, the time from triage to surgery decreased from 33.8 h (+/-21.3) pre bleep to 18.7 h (+/-7.9) post bleep (p = 0.032). We believe the bleep as a trigger to facilitate early multidisicplinary involvement is contributing to more positive outcomes in our Trust. [Conference abstract]</span></span>
700			_aEzihe-Ejiofor, J.A.
700			_aAsopa, V.
856			_uhttps://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.13224
999			_c76598 _d76598