Dawn Hip Initiative: Can Early Intervention Combat Hip Fractures?
"One year after implementing the 'Dawn Hip' protocol, a UK hospital demonstrates the impact of early surgical intervention on hip fracture outcomes, costs, and patient care. Uncover the findings and benefits."
Osteoporosis poses a significant and increasing burden due to its impact on mortality, morbidity, and the substantial expenses associated with clinical care for an aging population. In England, during 2012-2013, there were almost 400,000 fractures reported at hospitals, predominantly among older individuals. Hip fractures represent over a quarter of these cases and are among the most devastating fragility fractures. The incidence of these fractures has been rising by approximately 2% annually, and projections suggest that if this trend continues, the current number of 113,000 cases will increase to 130,000 by 2020.
Among those who survive hip fractures, only half will regain their pre-fracture level of independence. The other half will experience a decline in their walking ability, requiring them to use additional walking aids or seek physical assistance. Additionally, 20% of patients admitted from their homes will need to be discharged to residential or nursing homes. Hip fractures also carry a significant mortality risk, with a 10% mortality rate at one month, increasing to 30% at one year.
The direct medical expenses associated with fragility fractures to the National Health Service (NHS) were estimated at £1.8 billion in 2000, with the majority of these costs linked to hip fracture care. The British Orthopaedic Association (BOA) emphasizes that providing excellent care for hip fracture patients is more cost-effective than managing them poorly. Early medical and anesthetic assessment, surgical intervention, and rehabilitation have been proven to yield significantly better outcomes, not only for patients but also for the trust, with length of stay accounting for the majority of the overall hospital cost.
What is the Dawn Hip Initiative?
The 'Dawn Hip' initiative was implemented to address the challenges of meeting national targets for neck of femur fracture care. The initiative aimed to ensure that patients medically fit for surgery receive it within 48 hours of admission and during normal working hours, as recommended by BOA guidelines published in 2007. This initiative involved a dedicated effort to start the CEPOD (Confidential Enquiry into Perioperative Deaths) emergency theater lists with a neck of femur fracture case as early as possible.
- Prioritize Early Surgery: The initiative aimed to ensure that patients medically fit for surgery receive it within 48 hours of admission and during normal working hours.
- Optimize Theater Lists: Efforts were made to start CEPOD emergency theater lists with a neck of femur fracture case as early as possible.
- Dedicated Staff: An orthopedic registrar was assigned to each day of the five-day week.
- Patient Preparation: The on-call team identified patients the night before, and the on-call anesthetist was informed. The patient was reviewed and optimized for surgery to start at 8 am.
- Data Tracking: The procedure, start and anesthetic time, and duration were recorded. Data were collected one year later to assess the initiative's impact.
The Future of Hip Fracture Care
The 'Dawn Hip' initiative demonstrates a practical and effective strategy for improving hip fracture care, highlighting the importance of early intervention and multidisciplinary collaboration. The initiative's success underscores the need for a cultural shift in healthcare, emphasizing proactive and coordinated approaches to patient care. Through continued dedication and refinement, healthcare providers can further enhance outcomes, reduce costs, and improve the quality of life for individuals affected by hip fractures.