The positive impact of a quality improvement collaborative on process indicators for geriatric hip fracture care

Abstract

Summary: Adherence to guidelines for geriatric patients with a hip fracture is challenging. With this study, adherence to important quality indicators in geriatric hip fracture care was improved. A quality improvement collaborative including benchmarking and knowledge sharing showed to be effective in improving quality of care. Background: Adherence to guidelines for geriatric patients with an osteoporotic hip fracture is challenging. Therefore, the aim of this study was to improve the adherence to quality indicators (QIs) for these patients using benchmarking and knowledge sharing. Method: A prospective multicenter study was initiated throughout 19 hospitals in Flanders, Belgium. Adherence to 23 QIs was measured. Two retrospective audits (based on patient record analyses) were conducted in 2018–2019 (measurement period (MP) 1) and 2021 (MP 2). Between both audits, anonymous benchmarking was provided to the participating centers and three educative sessions on specific topics were performed. Results: A total of 1044 patients were included in the study. At MP 1, QIs showing the lowest adherence rates were the administration of nerve blocks, steroids, and tranexamic acid, applied in only 8.0%, 9.7% and 22.2% of the patients, respectively. At MP 2, these adherence rates significantly improved up to 25.4%, 26.4% and 30.7%, respectively (p < 0.001). The indication of the start of discharge planning also significantly improved between both periods (89.3% in MP 1 vs. 93.7% in MP 2, p = 0.043), while the avoidance of intra-operative hypotension was less well realized (56.2% in MP 1 vs. 52% in MP2, p = 0.026). Overall adherence significantly increased from 61.7 to 64.5% (p < 0.001). Delirium was significantly reduced (from 22.1% in MP 1 to 17.4% in MP 2, p = 0.030). Conclusion: Benchmarking in combination with a peer-reviewed and knowledge sharing intervention increases the adherence to quality indicators for patients with a geriatric hip fracture.