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Drivers of Delayed Time to Surgery for Hip Fracture Patients: A Multi-Center Qualitative Study
Emily A Schultz1, Jessica M Welch, William Cross
1From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Schultz, Gardner, and Kamal), the Department of Orthopaedic Surgery, Duke University, Durham, NC (Welch and DeBaun), the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. (Cross and Holte), the Department of Orthopaedic Surgery, Scripps Clinic, San Diego, CA. (Shah), the Department of Orthopaedic Surgery, Kaiser Permanente, Oakland, CA (Mansuripur), the Department of Orthopaedic Surgery, Boston University, Boston, MA (Kain), the Department of Orthopaedic Surgery, Precision Orthopedics and Sports Medicine, Irving, TX. (Lee), the Department of Orthopaedic Surgery, OrthoArkansas, Little Rock, AR. (Burn), the Department of Orthopedic Surgery, OHSU-Hillsboro Medical Center, Hillsboro, OR. (Hall), the Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA (Willey), the Department of Orthopaedic Surgery, University of Arizona Phoenix, Phoenix, AZ (McKee), the Department of Orthopaedic Surgery, Orthopedic Physician Associates, Seattle, WA (Pang), the Department of Orthopaedic Surgery, White Plains Hospital Physician Associates, White Plains, NY. (Douglass), the Department of Orthopaedic Surgery, NYU Langone Health, New York, NY. (Egol), the Department of Orthopaedic Surgery, University of Texas at Austin, Austin, TX (Laverty), the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO. (Miller), the Department of Orthopaedic Surgery, Prisma Health (Jeray), the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Schenker), the Novant Health Fracture Clinic, UNC SOM-Charlotte, Charlotte, NC. (Cannada), the Department of Orthopaedic Surgery, University of Miami, Coral Gables, FL (Hernandez), the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Mehta), the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA (Wustrack, Morshed and Shapiro), the Department of Orthopaedic Surgery, Salem Orthopedics, Salem, OR. (Mitchell), and the Department of Surgery (Morris, Harris) and the Department of Health Policy (Baker), Stanford University, Stanford, CA.
Introduction:
Delays in time to surgery (TTS) for patients with a hip fracture negatively affect patient outcomes, including mortality. Surgery within 24 to 48 hours of admission for a hip fracture markedly reduces these risks; however, attempts at improving TTS after hip fracture have had mixed results. Drivers of delays in TTS across different settings in the United States are not well described. Therefore, the aim of this study was to identify drivers of delays in TTS for patients with a hip fracture from different settings to inform where patient- and context-specific improvements in TTS may be implemented.
Methods:
Semistructured interviews were completed using the Consolidated Framework for Implementation Research and Theoretical Domains Framework. Interviews were completed with stakeholders involved in hip fracture care between June 2023 and October 2023. Transcripts were analyzed iteratively through a combined inductive and deductive approach. The data were analyzed to synthesize overarching themes related to drivers of delays of TTS.
Results:
A total of 25 stakeholders, 24 orthopaedic surgeons, and 1 nurse practitioner, from 22 different hospital systems across the United States participated in semistructured interviews. Eight themes of drivers of delayed TTS emerged: (1) patient health; (2) structural drivers of health; (3) care coordination; (4) prioritization; (5) improvement climate; (6) availability; (7) incentive structure; and (8) empowerment.
Conclusion:
Eight major themes related to drivers in TTS for patients with a hip fracture were identified across hospital systems. These findings inform the process of identifying site-specific drivers of delayed TTS at individual health systems and implementing targeted improvement programs for TTS for patients with a hip fracture.
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