ARTHUR – Avoiding readmission after hip fracture - version 3.0
Research type
Research Study
Full title
Avoiding re admission after hip fracture
IRAS ID
330074
Contact name
Emma Sutton
Contact email
Sponsor organisation
University of Birmingham
Clinicaltrials.gov Identifier
23/WM/0242, REC reference
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Hip Fracture is a big problem. In the UK around 75,000 people are admitted to hospital with a broken hip every year. Many patients who break their hip have experienced a fall from a chair or a trip. A broken hip can also be a sign of ‘weak’ bones – osteoporosis.
If you experience a broken hip you are much more likely to survive than you would have done 10 years ago. But you have a greater chance that you will need to return to hospital within the first month of discharge. Re-admission is increasing every year but the number of people falling and breaking their hip is not rising. We want to know what causes readmission. It might be problems with the wound/dressings, mobility, or other medical conditions. It is possible that some people return to hospital due to avoidable problems in the healthcare system. For example, sometimes information is missing or poorly reported in the discharge summary, which is sent to patients’ GPs. This can result in errors happening like delaying patients’ staring rehabilitation which could result in reduced mobility and falling again.
During this study we want to identify what ‘avoidable’ means; whilst ensuring we do not stop those people who need to be re-admitted returning to hospital. We also want to know what might influence readmission in case it could be avoided. Finally, we will present our findings and ask patients, carers and healthcare staff to help us explore what should be done to tackle avoidable readmission after hip fracture. This information will all be used to design an interventions to test in a future study.
LAY SUMMARY OF STUDY RESULTS:
The original study was developed and reviewed by 15 members of the Birmingham Clinical Research Ambassador Group (CRAG), a community stakeholder group, based at University Hospital Birmingham, with experience of trauma or critical care. The group helped us make sure our research trial asked the questions which were relevant to patients, and that we would collect data sensitively and appropriately. After the funding was received, the study team continued to meet with the CRAG group, but we also developed a separate Patient and Public Involvement (PPI) group which included seven members of the public who had experience of having a hip fracture or caring for someone who had a hip fracture. The Birmingham 1,000 elders (The Birmingham 1000 Elders group - University of Birmingham) supported us to recruit into our hip fracture PPI group. These members of the public gave advice on how to approach people to invite them to join the study, how to get the most from interviews with patients and their carers and they helped with interpreting the findings particularly what might be most impactful for preventing readmission.
Why was the research needed?
Hip Fracture is a big problem. In the UK around 75,000 people are admitted to hospital with a broken hip every year. Many patients who break their hip have experienced a fall from a chair or a trip. The number of patients who return to hospital, within 30 days of being discharged after a broken hip, is higher in Birmingham in comparison to the rest of England. Unfortunately, people who are readmitted within 30 days of discharge following a major trauma such as hip fracture are more likely to die, or experience other complications. We wanted to know why people following hip fracture in Birmingham were more likely to be readmitted and what might be possible to change or adapt to avoid readmissions in the future.
What were the main questions studied?
Why do people need to be readmitted to hospital within 30 days of breaking their hip?
What can be done to reduce avoidable readmission for people who experience a broken hip?
Where and when did the study take place?
The study took place between June and September 2024. Participants were recruited from two large West Midlands NHS Trusts providing care in a large acute hospital, and in smaller community settings What happened during the study?
We looked at the patient’s journey from arrival at Accident and Emergency through to discharge and return to their own home in order to identify any factors, systems or processes that might contribute to readmission. We thought that some of the reasons people return to hospital may be able to be changed or improved. For example, sometimes information is missing from the discharge summary sent to a patients’ GP that delays starting rehabilitation when home; this could result in reduced mobility and falls.
We observed NHS staff during eleven routine staff meetings to identify what were the challenges they discussed when planning care for patients during the original and subsequent admission. We also interviewed twenty-four people including NHS staff, patients and their carers. We interviewed some patients and family carers together, and sometimes separately.
What were the results of the study?
We found that there were challenges within the health care system which could be changed. First, people spoke about the system in terms of the hip fracture pathway (periods of nil by mouth or fasting, and delays in receiving community rehabilitation). Second, people spoke about communication and factors that made this good (e.g clear information and approachable staff) or challenging (e.g inadequate or missing information). Third, people spoke about ‘burden’ – For patients and carers this sometimes related to loneliness and feeling overwhelmed with decisions they needed to make and cost/funding (e.g for purchasing equipment). For staff burden was often related to a work-place pressure (e.g a pressure to discharge). The participants suggested twenty-two interventions which could help solve some of these problems. These 22 interventions related to four main challenges: 1. adequacy of information, 2. Individualised care, 3. access to services and 4. the hip fracture pathway.How has this study helped patients and researchers?
This study has helped understand what aspects of the care process might impact on whether patients need to be readmitted. These can now be looked at in more detail to see if they could form part of an intervention to reduce readmission after hip fracture.
Details of any further research planned
We want to explore the experiences of patients admitted with a hip fracture who have a cognitive impairment, and those who care for them as they were not recruited to the ARTHUR study. This group of patients may have unique challenges that would enrich what we know. Then we intend to design and test interventions for patients, carers and staff that might reduce the number of people are readmitted after hip fracture.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
23/WM/0242
Date of REC Opinion
25 Jan 2024
REC opinion
Further Information Favourable Opinion