Hip fracture management in the ED and in the hospital

The Hospital

University of California Davis School of Medicine

The Need

Patients with hip fractures have significant mortality and significantly increased morbidity. Pain management should start in the ED with multi-modal analgesia.

The Improvement

Multi-modal analgesia is effective and opioid sparing. In the ED, introduction of the pathway reduced opioid dosing in the first 24 hours.  For the larger hospital program, the geriatric fracture program has significantly reduced length of stay.

The Challenges and Drivers

• Multi-disciplinary team, ongoing education particularly for insertion of the fascia iliaca compartment block.
• Education of the Hospitalist service about which service patient should belong to (internal medicine for medically unstable patients versus orthopedics for medically stable patients) as part of the larger geriatric fracture program.
• Ongoing education for orthopedic residents.
• Delayed introduction of PDSA improvements to EMR

Outcomes

• Reduced opioid dosing x 24 hours.
• Association with reduced delirium.
• Hospital LOS reduced by nearly 2 days.