Audit of the effect of a fast tracking protocol on transfer time from A&E to ward for patients with hip fractures.

Abstract

The objective of this project was to study the effect of a "fast tracking protocol" on the time spent in the A&E department by patients with hip fractures. A review of 104 patients with hip fractures admitted via the A&E department between March 1997 and September 1997 (7 months) in a District General Hospital (Alexandra Hospital, Redditch) showed that many patients spent more than 2 h lying on uncomfortable trolleys in the department. A fast tracking protocol was devised for a quicker as well as safe transfer of these patients to the ward. This was implemented from December 1997 and its effects closely monitored on a monthly basis for the next 7 months up to June 1998. Results showed that the fast tracking protocol produced a significant reduction in the time spent in the A&E department by 90 out of the 100 patients with hip fractures. The transfer time (mean+/-SD) before the fast tracking process was 2 h 45 min +/- 57 min (N=104, median=2 h 40 min). After the protocol was implemented this was reduced to 1 h 32 min +/- 40.87 min (N= 90, median= 1 h 25 min). This reduction is statistically significant (p < 0. 001; Student t test). Also, more patients were transferred within the target time of 1 h (24 out of 90 patients) compared with before the introduction of the protocol (3 out of 104 patients). This was also statistically significant (p < 0.001; Chi-square test). Ten out of 100 patients were not fast tracked because of multiple injuries, acute medical problems or inconclusive diagnosis. These patients still spent an average of 2 h 55 min (median 2 h 55 min) in the A&E department. In conclusion, the fast tracking protocol significantly reduces time spent in the A&E department by patients with isolated hip fractures. There is also a significant increase in the number of patients transferred within the hour. This has numerous benefits for the patients as well as the A&E department.