Quality assurance in segmental neck of femur fractures

• Published in: International journal of health care quality assurance 2018-07, Vol.31 (6), p.474-482
• Main Authors: Harshavardhana, Nanjundappa S, Rathnayake, Kalana, Tanagho, Andy, Cree, Calum
• Format: Article
• Language: English
• Subjects: Anemia; Best practice; Cardiac arrhythmia; Cost control; Delayed; Delayed Diagnosis; Diabetes; Electrolytes; Femoral Neck Fractures - surgery; Fracture Fixation, Internal - standards; Fractures; Governance; Health administration; Hospitalization; Hospitals; Humans; Implants; Injuries; Joint replacement surgery; Medical diagnosis; Medical imaging; Morbidity; Mortality; National guidelines; Neck; Organizational Case Studies; Orthopedics; Patients; Practice Guidelines as Topic; Prostheses; Quality Assurance, Health Care - organization & administration; Quality Assurance, Health Care - standards; Quality control; Quality of care; Recovery; Rehabilitation; Sepsis; Surgery; Tariffs; Transplants & implants; Trauma; United Kingdom
• ISSN: 0952-6862; 1758-6542
• DOI: 10.1108/IJHCQA-09-2017-0167

Purpose The purpose of this paper is to report a rare case of segmental neck of femur fracture (SNoFF) and highlight its quality assurance and governance implications with respect to national guidelines, care pathways and best practice tariff. Design/methodology/approach Case report of an SNoFF in a 67-year-old woman treated at a district general hospital (DGH) was used in this study. Findings SNoFF required additional implants that delayed the surgery by five days. The authors were unable to adhere to the British Orthopaedic Association standards for trauma and Scottish Inter-Collegiate Guidelines Network recommendations which indicate that all neck of femur fractures (NoFFs) be fixed within 48 h. Though the patient was discharged without any untoward event and had an uneventful recovery, this case led us to introspect and learn how best to avoid such an incident from repeating again. Research limitations/implications This case led to an overhaul of NoFF and trauma services. The local logistics was restructured to procure “Trochanteric grip plates” within 24 h to provide mandated quality of care in an effort towards improving patient experience/outcomes. Originality/value SNoFF are rare injuries and its diagnosis is either delayed or missed in at least 20 per cent of the cases on initial evaluation. The non-availability of additional implants readily on the shelf coupled with lack of a trauma bed at the tertiary centre resulted in an unacceptable delay from admission to definitive surgery. The authors recommend that all DGHs have a mechanism/emergency procurement procedure system in place to obtain the required instrumentation kits rapidly through a sharing scheme with regional hospitals or through implant vendor to avoid unacceptable delays to surgery.