Key result
A targeted quality improvement intervention significantly increased compliance with early confusion and vitamin D screening in elderly hip fracture patients from 27% to 52.4% (p=0.0003).
Why the study?
Preoperative screening practices for postoperative delirium risk factors, such as cognitive impairment and vitamin D deficiency, are often inconsistent in elderly hip fracture patients.
Does a targeted educational and checklist intervention improve compliance with early confusion and vitamin D screening in elderly hip fracture patients?
Does a targeted educational and checklist intervention improve compliance with early confusion and vitamin D screening in elderly hip fracture patients?
Targeted educational interventions and checklist integration significantly improved compliance with early confusion and vitamin D screening in elderly hip fracture patients.
May encourage education and checklists to raise screening rates in elderly hip fracture patients; leaves open effects on clinical outcomes.
Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent. This quality improvement initiative aimed to assess and improve compliance with early confusion and vitamin D screening in elderly hip fracture patients, with the goal of facilitating timely interventions to reduce the risk of POD. Methods A two-cycle audit was conducted in the Trauma and Orthopaedics Department at Royal Shrewsbury Hospital. The first cycle (April-June 2023) assessed baseline compliance with confusion (Abbreviated Mental Test Score (AMTS)) and vitamin D screening within 24 hours of admission. Identified barriers informed an intervention consisting of educational sessions, visual prompts, and checklist integration. The second cycle (August-October 2023) evaluated the impact of these measures. Compliance rates, timing of assessments, and prevalence of abnormal biochemical and cognitive screening results were analyzed using Fisher's exact test (p < 0.05). Results Baseline compliance with screening was 27 patients (27%) out of 100, with primary barriers including lack of awareness and logistical challenges. Post-intervention compliance improved significantly for 54 patients (52.4%) out of 103 (p = 0.0003). Screening timeliness also increased, with 45 patients (83.33%) out of 54 screenings completed within 24 hours in cycle 2 compared to 14 patients (51.85%) out of 27 in cycle 1 (p = 0.0039). Biochemical analysis revealed persistently high rates of vitamin D deficiency, underscoring the need for early detection. AMTS scores correlated with abnormal confusion screens but highlighted limitations in cognitive-only assessments. Conclusion This quality improvement (QI) initiative demonstrated the efficacy of targeted interventions in improving screening compliance for confusion and vitamin D deficiency in elderly hip fracture patients. The findings advocate for integrating proactive, dual-focused screening protocols into clinical workflows to address modifiable risk factors for POD. Future research should explore the long-term impact of such measures on POD incidence, recovery trajectories, and functional outcomes while emphasizing the need for sustained adherence to screening protocols.
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Younis et al. (2024) studied Hip fracture (n=203). Educational sessions, visual prompts, and checklist integration vs. Baseline practice (pre-intervention) was evaluated on Compliance with confusion and vitamin D screening within 24 hours of admission (p=0.0003). A targeted quality improvement intervention significantly increased compliance with early confusion and vitamin D screening in elderly hip fracture patients from 27% to 52.4% (p=0.0003).
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