2024 FSA Podium and Poster Abstracts
S008: OPTIMIZING TIMING TO THE OPERATING ROOM: ADVENTHEALTH'S ORTHOPEDIC INSTITUTE HIP FRACTURE PILOT STUDY
Rutva Vora1; Douglas Stewart, MD, Anesthesiologist2; Robert Bryskin, MD, Anesthesiologist2; Michael Hawks, MD, Orthopedic Surgeon3; Jason Croft, MBA3; Jillian Shaw, BSN, RN3; Heather Gentry, BSN, RN3; 1Florida State University College of Medicine; 2US Anesthesia Partners; 3AdventHealth
Introduction: A delay in surgical intervention for hip fractures for more than 24 hours has been associated with higher complications and increased mortality risk within the subsequent 30 days, as well as linked to increased length of stay and greater healthcare expenses. Although some international studies have examined the efficacy of pilot initiatives in enhancing outcomes for patients with hip fractures, research is limited, especially within the US healthcare system. The aim of the AdventHealth’s Orthopedic Institute Hip Fracture Pilot study was to optimize timing to the operating room (OR), via collaboration with the Anesthesia team, to reduce the risk for morbidity and mortality while concurrently reducing the duration of hospitalization for patients with hip fractures.
Methods: The inclusion criteria consisted of patients with hip fractures arriving at AdventHealth Orlando Emergency Department (ED) between 7 am and 5 pm from April 2023 to September 2023. The study included 55 patients meeting these criteria. Patients arriving outside of these hours were excluded due to limited staff. Among the patient population, one had an ASA score of 1, seven had a score of 2, forty had a score of 3, and seven received a score of 4.
To enhance efficiency, algorithms, including a process map and an advanced cardiology clearance pathway, were created, and disseminated to the medical team. The multidisciplinary team, including EMS, ED, Imaging, OR Team, Orthopedic Surgeons, and others, collaborated on this initiative. Anesthesiologists played a pivotal role in streamlining the process by coordinating preoperative assessments and optimizing patient readiness for surgery.
The average Door to OR time and length of hospital stay were measured for the patient population and compared to baseline data from August 2022 to January 2023, comprising 505 patients, before the algorithms were implemented. Furthermore, 30-day postoperative clinical outcomes such as mortality, sepsis, unplanned intubation, unplanned readmissions, and other factors were evaluated and subsequently benchmarked against the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).
Results: The average Door to OR percentage within 24 hours increased from 26.4% to 78.2%. The average Door to OR time in hours showed a reduction from 41.5 hours to 18.18 hours. Moreover, the average length of hospital stay decreased from 6.9 days to 5.35 days. Of the 11 metrics evaluated for postoperative outcomes, 8 met or exceeded the expected performance level according to NSQIP benchmarks. However, sepsis, unplanned intubation, and unplanned readmissions were classified at the "Area of Opportunity" level.
Conclusion: The results highlight the importance of timely surgical intervention in improving outcomes in patients with hip fractures. Through collaborative efforts with the Anesthesia team, enhancements were achieved in the timing to the OR and reduction in the average length of hospital stay.
A few limitations of the study include a relatively small sample size and lack of long-term risk-adjusted data. Addressing these limitations could strengthen the robustness and generalizability of this study. Overall, the insights gained from this study provide a strong foundation for further advancements in orthopedic to improve patient well-being and healthcare efficiency.