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Interventions to improve hip fracture guideline adherence for time to surgery and early mobilization: a systematic
Mitchell Sarkies1,2,3, Luke Testa4, Morag E Taylor5,6,7
1Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia. mitchell.sarkies@sydney.edu.au.
Background:
Clinical quality registries indicate that adherence to clinical practice guidelines for the management of hip fracture patients is often not as recommended. The aim of this systematic review is to evaluate interventions that improve adherence to hip fracture guideline recommendations for time to surgery and early mobilization.
Methods:
A systematic review and meta-analysis of English language studies published between 1st January 2000 and 12th March 2025, available from Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science was conducted. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Studies were included if they reported on interventions designed to improve time to surgery or early mobilization in the acute care period for patients aged 50 years and older admitted to hospital with a proximal femoral fracture.
Results:
Ten studies met inclusion criteria. Interventions to improve time to surgery and early mobilization included care pathways (n = 5), orthogeriatric models of care (n = 2), audit and feedback (n = 1), clinical supervision (n = 1), and pay for performance (n = 1). Interventions were associated with an overall small to moderate positive effect on time to surgery (n = 6, SMD 0.47, 95% CI 0.14 to 0.80, I2 = 97%), early mobilization after surgery (n = 6, SMD 0.33, 95% CI 0.13 to 0.54, I2 = 67%), and 30-90 day mortality (n = 7, Log Odds Ratio 0.21, 95% CI 0.19 to 0.23, I2 = 0%). No overall effect was found on functional outcomes (n = 5, SMD 0.29, 95% CI -0.04 to 0.61, I2 = 78%), length of stay (n = 7, MD -0.38, 95% CI -1.30 to 0.54, I2 = 99%) and readmission within 30-90-days (n = 3, Log Odds Ratio 0.25, 95% CI -0.58 to 0.08, I2 = 0%).
Conclusion:
Interventions to improve adherence to hip fracture clinical guidelines recommendations for time to surgery and early mobilization have the potential to yield small to moderate improvements in both time to surgery and early mobilization after surgery. However, caution should be exercised when interpreting these findings due to the presence of heterogeneity between studies.
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