Reducing Delayed Discharges After Neck of Femur Fracture Surgery in a Major Trauma Centre: A Retrospective Quality...

Background Delays between medical readiness for discharge and actual hospital discharge are a common challenge after neck of femur fracture surgery. These delays can prolong hospital stay, increase exposure to hospital-associated complications, occupy acute beds unnecessarily, and create additional distress for older patients and their families. Although hip fracture pathways often focus on time to surgery and orthogeriatric review, the discharge phase is less frequently examined as a target for local quality improvement. Methods We performed a retrospective before-and-after quality improvement study at a United Kingdom major trauma centre. Consecutive adult patients who underwent surgery for a neck of femur fracture between January 2025 and December 2025 were included. In July 2025, a multidisciplinary discharge-readiness bundle was introduced. This included setting an estimated date of discharge within 24 hours, daily criteria-led board rounds, early triggers for occupational therapy and social work input, escalation of weekend physiotherapy, pharmacy prompts for discharge prescriptions, and twice-weekly escalation meetings with community partners. The primary outcome was delayed discharge, defined as discharge occurring more than 48 hours after the recorded medically fit for discharge (MFFD) date. Secondary outcomes included the MFFD-to-discharge interval, postoperative length of stay, total length of stay, discharge destination, 30-day readmission, and inpatient mortality. Results Overall, 134 surgical neck of femur fracture cases were assessed, with 67 patients in each study period. Baseline patient characteristics were similar between groups. Following implementation of the bundle, delayed discharge decreased from 43/67 cases (64.2%) to 24/67 cases (35.8%) (odds ratio: 3.21, 95% confidence interval: 1.58-6.50; p = 0.002). The mean MFFD-to-discharge interval fell from 5.2 to 2.7 days (p < 0.001). Postoperative length of stay decreased from 18.9 to 13.7 days (p = 0.003), while total length of stay decreased from 21.4 to 16.1 days (p = 0.007). Discharge to the patient's usual residence increased from 44.8% to 62.7%. There was no observed increase in 30-day readmission or inpatient mortality. Conclusions Introduction of a multidisciplinary discharge-readiness bundle was associated with a meaningful reduction in delayed discharge after neck of femur fracture surgery at a major trauma centre. The intervention was low-cost, practical to implement, and was not associated with an increase in readmission or inpatient mortality. Further prospective evaluation should include balancing measures, patient-reported outcomes, and measures of community care capacity.