Hip fracture management

Implementing and scaling an evidence-informed model for hip fracture management

Project Members - Macquarie University

Dr Mitchell Sarkies – Chief Investigator

Dr Luke Testa – Post-Doctoral Research Fellow

Project contacts

Dr Mitchell Sarkies

Mitchell.Sarkies@mq.edu.au

Project Description

This applied research translation program will implement evidence-informed guidelines into healthcare practice for the management of people with hip fractures. The three priority areas of hip fracture care that I will address within the acute hospital setting are:

• surgery within 48 hours
• early post-operative mobilisation
• optimised pain management using nerve blocks.

Background

There is a trustworthy body of evidence to guide clinical management of hip fractures. However, despite the tragic consequences of hip fractures and existence of evidence-based Care Clinical Care Standards, best practice management is not always delivered. Until now, research translation efforts have followed a relatively linear and simplified trajectory, unable to overcome the global health system challenge to reduce gaps between evidence and practice. The proposed research program is about creating new knowledge from evidence-informed healthcare improvement initiatives, grounded in the realities of complex adaptive healthcare systems. My research translation efforts (T2-T4) will seek to advance the novel field of implementation science to study methods that promote the uptake of evidence-based practices into routine hip fracture care.

Aims

This project aims to improve the care provided in Australian hospitals for people with hip fractures.

Design and method

Healthcare manifests many features of complex adaptive systems. More than a complicated system, complex adaptive systems produce emergent phenomena that are difficult to predict due to feedback loops between health professionals, patients, technical processes and the hospital environment. Because healthcare systems can only be partially stochastic and probabilistically specified, this research program will reconcile complex systems science with implementation science in real-world health services, using: 1) system dynamics modelling; 2) social network analysis; and 3) realist evaluation methods. These observational designs will inform quasi-experimental studies to improve the organisation and management of hip fracture care across New South Wales hospitals.

Benefits

Approximately 50,000 Australians are hospitalised with hip fractures every year. Supporting health professionals to deliver care according to recommended guidelines will assist in reducing wait times for surgery, ensure more Australians with hip fractures get back on their feet after surgery, and help alleviate pain and suffering.

Funding acknowledgment

NHMRC Investigator Grant APP2007970