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Abstract Aim This quality improvement project aims to reduce the length of hospital stay in orthogeriatric neck of femur (NOF) fracture patients by preventing orthostatic hypotension during post-operative patient mobilisation through encouraging post-operative, pre-mobilisation oral fluid intake. Method Orthogeriatric NOF fracture patient notes and fluid charts were retrospectively reviewed to establish the pre-intervention baseline post-operative pre-mobilisation fluid intake. A separate cohort of newly admitted geriatric NOF fracture patients were followed prospectively, with an intervention administered one day post-operation to encourage fluid intake. This intervention consisted of a verbal reminder and leaflet encouraging oral fluid intake, along with a verbal explanation and patient information sheet on orthostatic hypotension. Adequate fluid intake was defined as ≥500 ml fluid intake before mobilisation, and a prolonged hospital stay was defined as ≥20 days. This was carried out at the Royal Derby Hospital from July to November 2023. Results A total of 41 patients were reviewed. 21 patients were in the pre-intervention group and 20 in the intervention group. The pre-intervention group had 23.8% (5/21) patients with adequate fluid intake prior to mobilisation. This was increased to 95% (19/20) in the intervention group. The pre-intervention group also had 61.9% (13/21) patients with a prolonged hospital stay which was reduced to 10% (2/20) in the intervention group. Conclusions Encouraging oral fluid intake post-operatively reduces the risk of postural hypotension, empowering patients to mobilise and recover post-operatively, contributing to earlier discharge. Additionally, it may reduce the risk of post-operative acute kidney injury, an avenue which should be further explored.
Tsang et al. (Mon,) studied this question.