Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

Area of Science:

• Geriatric Medicine
• Emergency Medicine
• Pain Management

Background:

• Over 300,000 low-trauma fragility hip fractures occur annually in the US.
• Multidisciplinary geriatric fracture programs (GFP) are known to reduce morbidity and mortality.
• Effective emergency department (ED) pain management is crucial for geriatric hip fracture patients.

Purpose of the Study:

• To evaluate the impact of a geriatric fracture program (GFP) on emergency department (ED) pain management.
• To assess changes in analgesic timing, type, and opioid administration post-GFP implementation.
• To determine if a structured program improves acute pain control for hip fractures.

Main Methods:

• Retrospective study comparing patients aged 65+ with fragility hip fractures before and after GFP implementation.
• Analyzed time to first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB), and 24-hour opioid dosage.
• Utilized permutation tests to assess statistical significance of observed differences.

Main Results:

• The post-GFP group (177 patients) showed increased use of FICB (6% to 60%) and acetaminophen (10% to 51%) in the ED.
• Time to first analgesic was reduced (103 to 93 minutes; p=0.04).
• Opioid administration decreased significantly, with fewer morphine equivalents given in the first 24 hours (15mg to 10mg; p<0.001).

Conclusions:

• Implementation of a geriatric fracture program (GFP) is associated with enhanced emergency department pain management for hip fracture patients.
• The study highlights improved analgesic strategies, including increased non-opioid use and reduced opioid reliance.
• Further research is recommended to explore the long-term outcomes associated with these improved pain management protocols.