Physiotherapy for patients with Fracture Neck of femur- A retrospective evaluation report on weekend services during the acute phase

Purpose

The purpose of this study was to evaluate the established physiotherapy weekend service provided to fractured NOF patients within our institute. The primary objectives were to determine how many of those patients identified as priorities for weekend treatment were reviewed, ascertain barriers to treatment and if the quality of treatment given was appropriate in relation to the patients’ identified goals.

92.7% of patients with #NOF repair
were reviewed at least once during the weekend.

Approach

Using electronic notes and ward books, all adults who had sustained fractured NOFs over a 9 week period and were listed for the weekend physiotherapy service were retrospectively identified. Data was extracted using a pre-defined table which included the following; number of days post operation, fixation type, weight bearing status, cognition baseline, weekend priority, treatment given and reasons initial goals were not met.

Outcomes

Results: In Total 82 post surgical patients with a fractured NOF were listed. Majority were 4-5 days post-op. 56/82 were listed as doubles (requiring assistance of 2) and 26/82 were singles. 76/82 (92,7%) were reviewed at least once during the weekend. The remaining 6 were not reviewed due to time constraints, pain and or discharged. 57.9% were seen on both days.Only 52.6% of the group achieved their therapy goals. Barriers to goals not being met included: time constraints (51.3%), initial assessment (9.2%) and patient decline (6.6%). 44% of the sample had a cognitive impairment, but only 3.9 % of rehabilitation sessions were affected by this. All 7 patients prioritised for their initial post surgical assessment stood up the day after surgery, meeting the best practise tariff. Pain, fatigue and difficulty following instructions limited 3/7 from walking on day 1. The most commonly utilised treatment interventions involved post-surgical exercises and mobility practise. Less than 10 sessions specifically targeted balance and gait re-education during the weekend.

Conclusion(s): The literature acknowledges the risk of sustaining a neck of femur fracture increases with age and is more evident in those aged 80 years and over. The service report concluded that; weekend staffing was adequate, the main barrier to the quality of treatment received was time constraints and in a population group prone to falls only a small proportion of sessions specifically targeted balance and gait re-education. This highlighted a necessity for a review of treatments that could be confined to a bed space /bay to make it effective and time efficient.

Cost and savings

No further data. 

Implications

The retrospective service evaluation identified a necessity for a review of treatments confined to a bed space/bay to make it more time efficient & effective and highlighted 2 main service improvement actions. 1. Creation and sharing of digital prompt phrase for staffs to identify SMART therapy goals to be completed over a weekend. 2. Development and implementation of a balance and gait re-education program that could be completed around the bay/bed space

 

Top three learning points

No details 

Funding acknowledgements

No funding was received for this.