Aims: To evaluate whether implementation of a structured nurse-led weekday huddle reduced time to surgery for older patients with hip fractures.
Methods: A pre- and post-intervention observational study was conducted at a metropolitan public hospital in Victoria, Australia. Patients aged 50 years or older undergoing surgery for native hip fractures between October 2022 - March 2023 (pre-intervention) and October 2023 - March 2024 (post-intervention) were included. The intervention modified an existing nurse-led weekday huddle to include a structured agenda item identifying and prioritising hip fracture patients. The primary outcome was time to surgery (hours from emergency department presentation to surgery start). The secondary outcome was surgery within 36 hours. Group comparisons and multivariable linear regression were performed adjusting for demographic and system-level confounders.
Results: 247 patients were included (123 pre- and 124 post-intervention). Mean time to surgery was 41.0 hours pre-intervention and 38.3 hours post-intervention (p=0.621). On adjusted analysis, the intervention was not associated with reduced time to surgery (β=5.34 hours, p=0.367). Admission to outlying wards was independently associated with prolonged time to surgery (β=31.73 hours, p<0.001). Surgery within 36 hours increased from 53.7% to 59.7% (p=0.340).
Conclusions: A structured nurse-led huddle did not significantly reduce time to surgery, although modest improvements were observed. Delays associated with outlying ward admission highlight system-based factors influencing timely hip fracture care and may inform future quality improvement initiatives.