SRS281 - Impact of emergency department triage documentation on timely admission of hip fracture patients

Aim Timely admission from ED to an orthopaedic ward is a key quality indicator in hip fracture care. Irish Hip Fracture Standard 1 (IHFS-1) recommends admission within 4 h. In St. Vincents University Hospital, admission within 3.5 h of the decision to admit (DTA) timestamp is used as a pragmatic surrogate to remove bed availability delays. This audit evaluated the impact of ED triage documentation on achieving this target. Methods A retrospective audit was conducted of 115 hip fracture attendances between 1 October and 31 December 2024. Data was extracted from ED triage records and patient notes. Four triage elements were examined: (1) pre-alert, (2) ‘hip fracture suspected’ documented, (3) shortened/external rotation documented, and (4) Documentation of weight bearing status. Provision of fascia-iliaca nerve-blocks was also recorded. The primary outcome was admission within 3.5 h of DTA. Associations were evaluated using χ² tests and cumulative documentation analysis. Results Of 115 cases, 60 (52.2%) achieved the 3.5-hour target. Timely admission was significantly associated with pre-alerting (75% versus 45%, P = 0.005) and explicit documentation of ‘hip fracture suspected’ (65% versus 42%, P = 0.016). Provision of fascia-iliacanerve blocks also improved admission rates (59% versus 36%, P = 0.031). Documentation of limb position and weight-bearing status alone showed no significant association. Admission rates increased with documentation completeness: from 23.5% (no items) to 63.2% (≥3 items). Conclusions Clear triage communication, particularly pre-alerting and explicit documentation of suspected hip fracture, significantly improves timely admission. Standardising these documentation practices and analgesia protocols may enhance IHFS-1 compliance and optimise patient outcomes.