Seven potential sources of delay to surgical repair of hip fracture identified during a WRHA audit in 2008 along with the actions taken to address sources of delay
| Potential sources of delay | Actions taken to address sources of delay |
|---|---|
| i) Time required to transfer patients from rural hospitals without surgical facilities to WRHA hospitals with surgical facilities | i) Development of an orthopedic surgery coverage algorithm that matched WRHA hospitals with rural hospitals and required WRHA hospitals to accept rural patients regardless of bed availability |
| ii) Routing rural patients through the receiving hospital’s emergency department rather than going directly to the surgical ward | ii) Direct transfer of patients from rural hospitals’ emergency departments to the surgical ward at the accepting hospital |
| iii) Availability of operating room time | iii) Creation of additional daytime orthopedic trauma slates to accommodate patients during regular working hours and clarification of prioritization rules so that hip fracture patients who are “bumped” from surgery one day receive high priority the next day |
| iv) Lack of uniform understanding among all care providers of the association between delayed time to surgery and outcome | iv) Education in the form of combined orthopedics, anesthesia and internal medicine rounds on the importance of timeliness of surgery and common reasons for delay |
| v) Lack of consensus between surgeons and anesthesiologists about the timing of surgery in patients on clopidogrel | v) A collaborative determination by the WRHA anesthesia and orthopedic standards committees that clopidogrel in and of itself need not delay surgery |
| vi) Mandatory internal medicine consultations in order to be cleared for surgery | vi) The use of internal medicine consultations only when a correctable serious medical condition was identified preoperatively (e.g., an uncontrolled arrhythmia or congestive heart failure) |
| vii) Difficulties repatriating patients to home hospitals after surgery, resulting in a functional bed shortage for new patients | vii) WRHA surgery program collaborated with rural health regions to improve repatriation of patients once fit for transfer following surgery |
WRHA = Winnipeg Regional Health Authority.