Fractured Neck of Femur Clinical Pathway Use in Tasmanian Emergency Departments: A Retrospective Study

The emergency department (ED) has a critical role in initiating early treatment for fractured neck of femur (fractured NOF). Delayed treatment is associated with adverse outcomes. The primary objective of this study was to retrospectively examine the use of a fractured NOF formal pathway document. Secondary outcomes assessed pathway compliance, impact on waiting times, and differences across Tasmanian EDs to guide local quality improvement.

Descriptive retrospective study with random sampling of 200 fractured NOF cases across three regional hospital EDs.

Of the 195 fractured neck of femur (NOF) ED presentations across three sites, 155 (79.5%) used the pathway. Nerve block administration showed a statistically significant association with pathway use, with a relative increase of +44.9% (95% CI: +15.0% to +83.0%, p < 0.000001). MiniCog screening showed a notable relative increase of +93.5% (95% CI: +1.0% to +271.0%) but did not meet the significance threshold. MiniCog assessment differed significantly between hospitals H1 versus H2 and H1 versus H3 (p < 0.00001). Goals of care completion showed some variation (p = 0.0033) but was not statistically significant. Pathway use did not significantly affect waiting times, length of stay, or representation rates. Hospital comparisons revealed significant differences in waiting times and length of stay.

This study suggests that pathway use was associated with significant increases in the administration of nerve blocks. Significant differences in pathway use, element completion, and associated waiting times were reported between hospitals. Findings support the pathway's role in standardising care and guiding targeted quality improvement efforts.