Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery

BMC Musculoskeletal Disorders

Research

XL Griffin¹  S Drew²  R Patel²  CL Gregson²  F Fox²  R Gooberman-Hill³  TJS Chesser⁴  MK Javaid⁵  A Johansen⁶ 

[1] Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK;Barts Health NHS Trust, London, UK;Bristol Medical School, University of Bristol, Bristol, UK;Bristol Medical School, University of Bristol, Bristol, UK;National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK;Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK;Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK;University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK;

关键词: Hip fracture;    Qualitative;    Service delivery;    Multidisciplinary care;    Care pathway;    Communication;   

DOI  :  10.1186/s12891-023-06164-9

 received in 2022-06-30, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care.MethodsInterviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway.ResultsEffective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team.ConclusionFindings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1