Problem of Timely Repair of Hip Fractures in Patients Aged 65 and Older

Final Capstone Project
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Abstract
This project covers handling the critical demand to advance timely repair procedures for hip fractures in geriatric patients 65 years old or older in an emergency department (ED) environment. Its main goal is to improve adherence to the hip fracture repair procedure among ED providers via an educational empowerment strategy. The intervention strategy consists of skill-building sessions, frameworks, and equipment to educate and engage the ED workforce, leading to prompt and better hip fracture repair. The relevance of this project emerges from the severe health consequences and fatality risks tied to hip fractures among this at-risk population. Proper timing of surgery is key in achieving desired outcomes, yet continuously dealing with insufficient observance of the protocol remains a constant problem. Consequently, this project seeks to resolve this concern by significantly improving the quality of treatment, protection of patients, and their overall experience in healthcare, particularly for this at-risk group of patients. The implementation plan highlights designing and delivering instructional materials, coaching sessions, and conducting continuous assessments. It works towards ensuring ED providers’ participation and endorsement of a compliance culture to bring about sustainable change in implemented practices. The evaluation plan includes comprehensive data acquisition, evaluation, and feedback links to evaluate compliance figures with the hip fracture repair protocol prior to and after the implementation. The results indicate the impact of educational intervention in fostering compliance, leading to improved patient outcomes.
Keywords: emergency department, hip fracture, timely intervention, geriatric health, patient outcomes
Final Capstone Project
Introduction
This project focuses on tackling the problem of timely repair of hip fractures in patients aged 65 and over. As such, its target demographic is elderly patients with hip fractures coming to the emergency department requiring intervention within 24 hours to prevent further complications. The intervention program seeks to ensure prompt repair of hip fractures in aged patients by training emergency department caregivers on the hip fracture treatment protocol. This educational measure includes instruction workshops, principles, and implements tailored to guarantee increased protocol compliance. The significance of this project is based on how hip fractures in elderly patients are linked with high instances of complication, such as subsequent fractures or chronic pain, and death. While timely surgical procedures produce tor the best patient outcomes, low compliance with the recommended protocol for hip repair results in undesired patient outcomes. Addressing these requirements is key to improving the standard of treatment, the safety of patients, and the overall health service experience for this at-risk population. The plan of implementation includes the creation and provision of educational resources and training programs for providers in the emergency department. It also comprises supervision and feedback processes that ensure consistent compliance with the established protocol. The assessment framework involves gauging adherence rates to the hip fracture repair guideline pre- and post-deployment of the action. Data collection and analysis, coupled with constant feedback, play a key role in evaluating the effect of the intervention on enhancing compliance and subsequently improving patient results.
PICOT
Problem Statement (PICOT)
This project focuses on geriatric patients aged 65 and above with hip fractures in the emergency department (P) and whether implementing an educational intervention on the hip fracture repair protocol requiring surgical treatment within 24 hours (I) compared to standard practice (C) improves compliance rates with the protocol to above than 80% (O) within three months (T).
Need Statement
The core objective is to ensure compliance with the hip fracture repair procedure among elderly patients aged 65 and above, recommended within the initial 24 hours after injury. This quality control measure focuses on improving compliance with the protocol, thereby increasing the number of patients receiving timely surgical treatments. The demand is fueled by overwhelming proof that prompt hip fracture surgery considerably influences patient results, prevents complications, and adheres to best evidence practice. Efforts to fulfill this protocol adherence aim to improve safety and care for elderly patients suffering from hip fractures.
Population and Setting
This project targets elderly individuals aged 65 or older, hospitalized after suffering a hip fracture and requiring emergency surgical intervention. Such patients are at increased risk of fractures due to elderly falls and age-related changes in bone density, such as osteoporosis. The emergency department provides the context for this project, where patients are initially evaluated. Ensuring timely response in the emergency room setting is essential, as it can significantly influence patient outcomes and facilitate adherence to suggested protocols.
Intervention Overview
Educating emergency department physicians on the proper technique for repairing hip fractures is expected to improve compliance with the established 80% threshold. It will be delivered through an engaging educational format incorporating interactive seminars, case-study analyses, and sharing of educational resources. By enhancing physicians' understanding of the importance of early intervention, the specific steps of the protocol, and the collaboration required with cardiology and anesthesia services, this intervention aligns with the project's goal of improving compliance within the targeted population and setting.
Comparison of Approaches
This alternative method encompasses improved communication between medical professionals in these respective fields, including physicians, cardiologists, and anesthesiologists, to streamline the fracture repair protocol above the 80% threshold. As such, the strategy emphasizes teamwork and coordination amongst diverse medical specialties. Despite addressing communication challenges, this strategy could still fail to directly bridge the knowledge gap between physicians and the protocol's importance and steps. It might not thoroughly cover the demand for educational initiatives.
Initial Outcome Draft
The initial objective is to achieve an adherence level above 80% amongst geriatric patients in conforming to the hip fracture repair protocol within one day. This achievement quantitatively measures the project's effectiveness, showing how it increases adherence and improves patient care. Realizing this result is consistent with the primary goal of providing safety and quality care for geriatric individuals who have suffered hip fractures.
Time
The expected timeframe for the intervention's initial stage is roughly three to four months. This budget allocates time for creating educational content, scheduling and managing workshops, pursuing and securing required authorizations, and drafting material for practical discussions. While this timeline is reasonable, potential issues may arise when coordinating workshop schedules and obtaining buy-in from pivotal stakeholders. The intervention's implementation period is also expected to take six to eight months. Phase two consists of organizing sessions, sharing content, and assessing compliance. However, maintaining consistent collaboration with physicians and sticking to the protocol in the long term may present difficulties during this stage.
Literature Review
Extensive research has been published regarding adhering to the hip fracture repair protocol within 24 hours when treating geriatric patients. This evidence comes from numerous clinical studies emphasizing the importance of timely response in hip fracture cases among elderly patients. The research findings point towards a probable effect on patient results, healthcare efficiency, and resource utilization.
To begin with, the body of literature emphasizes the urgent need for prompt hip fracture intervention, particularly among elderly patients. Timely surgical treatment can considerably diminish potential further complications, including acute kidney injury (Borges et al., 2019). The conclusion underscores the significance of acting quickly to address hip fractures, improving patients' outcomes, and averting possible complications stemming from delayed care.
Evidence highlights a direct correlation between early intervention following a hip fracture and improved patient outcomes, including reduced mortality risks and enhanced functional recovery. The project details suggest that adhering to the recommended 24-hour time frame for surgery can have favorable consequences. Adding to previous studies, Wenk and Frey (2021) shed light on the significance of timely surgery in reducing postoperative complications in elderly patients and enhancing the quality of life.
Addressing hip fracture repair delays streamlines healthcare resource utilization within the emergency department. Delayed interventions regarding medical issues tend to produce extended hospital stays and higher use of healthcare services. Adopting the 24-hour protocol may enable hospitals to shorten patient stays, release available beds more quickly, and enhance resource utilization. Breda et al. (2022) corroborate this idea by expounding upon evidence-based care models tailored to better serve elderly patients with fractured hips, indicating the importance of optimizing healthcare resource allocation and utilization.
Furthermore, extensive research advocates for an intensified effort to address the healthcare requirements of aging populations. Attending to the initial fracture timely is vital, given the vulnerability of older adults to sustain subsequent fractures (Wang and Seibel, 2023). Consequently, this project focuses on addressing potential issues at their outset to ensure the sustained well-being and independence of the elderly population.
The available data suggests timely interventions for hip fracture repairs can have extensive significance for the healthcare industry. Hospitals can experience considerable savings in resources and costs when they follow the recommended protocol, resulting in improved patient processing. Providing older adult care can produce desirable results and optimize resource usage (Breda et al., 2022).
Various medical policies contribute to achieving this project's objective of ensuring timely compliance with the hip fracture repair protocol among older adults. These policies primarily revolve around patient safety, quality improvement, and standardization of care for elderly individuals with fractures (Okereke et al., 2021). For instance, the policies under consideration have far-reaching effects on the approach to address the need to educate the emergency response medical team on compliance with the set protocol for hip fracture repair. They influence considerations that must be included in the project and dictate certain approaches that may or may not be available due to policy constraints.
Key policies influencing safe and timely medical treatment are central to the strategy to address the intervention need. Healthcare policies highlight the significance of timely response to prevent further complications. Policies regarding hip fracture fixes could stress the urgency of prompt action to avoid unfavorable repercussions and achieve ideal patient outcomes (Boman et al., 2020). Therefore, compliance with the 24-hour recommendation when attending to hip fractures among older people is crucial. Emerging from the health policy, this project places great importance on imparting knowledge and raising consciousness amongst emergency responders regarding patient care standards. Any interventions designed to improve compliance must align with these policies to ensure patient well-being and adherence to recommended standards of care.
Health policies tend to promote and foster quality improvement in patient care delivery. Evidence-based quality improvement policies may require regular protocol assessment and modifications in healthcare settings. Health policies centered around hip fracture repair may drive hospitals to establish uniform standards and educational initiatives to guarantee quality and timely care for aging patients (Sepahvand et al., 2019). The policy convergence with this project's approach highlights the significance of implementing evidence-based interventions that comply with set protocols. This functionality allows for ongoing observation and examination of compliance to guarantee sustained quality improvements.
Health-related regulations concerning resource allocation and effectiveness could significantly impact the project's approach. High-pressure situations arise when hospitals must reconcile efficient resource utilization with quality patient outcomes (Erickson, 2020). Policies may inspire methods that speed up hospital discharge durations, supporting the project's objective of compliance with the 24-hour protocol. By implementing these policies, the project may adopt techniques that benefit both compliance and resource conservation. Enhancing resource allocation within surgical facilities is essential for meeting the goals.
Despite offering a structure for enhancing care, these policies may restrict certain methods. Brown et al. (2020) consider policies regarding patient consent, process protocols, and medication management, which may limit the project's capacity to intervene surgically for patients on anticoagulants quickly. An attentive review of these guidelines is essential to maintain patient safety and ensure legal compliance (Grandone et al., 2019). Moreover, the payment schemes and insurance coverage might affect the financial feasibility of recommended medical interventions, including timely surgeries in this context. The project should incorporate these elements to achieve optimal results, aligning with healthcare policies and standards.
Evidently, existing health policies substantially impact the approach to addressing the identified need to improve compliance with the hip fracture repair protocol for geriatric patients. Each of these factors shapes the project's comprehensive strategy. The guidelines offer guidance and support but pose difficulties that require careful handling to execute successful, safe, and regulatory-compliant operations.
Intervention Plan Design
This intervention plan design aims to enhance adherence to the hip fracture repair protocol in elderly patients within the emergency room and encompasses a thorough approach to boost patient results and quality of care. Given the rising geriatric population, surgical hip fracture treatment must be efficient. The intervention plan seamlessly combines evidence-based strategies, care coordination from various subspecialties, and innovative educational approaches to implement best practices effectively. Integrating relevant theoretical models, accounting for the interests of key stakeholders, navigating complex ethical and legal issues, and adhering to medical policies and guidelines, the proposed plan purposes to transform the landscape of emergency care for geriatric patients with hip fractures.
Intervention Plan Components
The key components of the intervention plan are designed to boost compliance with the hip fracture repair protocol for older patients. To begin with, it is imperative to establish a detailed educational program to instruct emergency department practitioners about the criticality of timely hip fracture repair within a 24-hour window. The training consists of diverse learning modes, such as hands-on activities, case study discussions, and sharing of learning materials. A coordinated communication system will also be established to expedite collaboration and consultation among various medical specialists, including ER physicians, cardiologists, and anesthesiologists. An intervention monitoring process will allow for continuous evaluation and adjustment of the plan.
The intervention plan seeks to boost compliance with the hip fracture repair protocol by leveraging these components. The educational program will allow doctors to make knowledgeable decisions and take prompt action. The enhanced communication method will help reduce delays by eliminating barriers to fast consultation and streamlining workflow (Boman et al., 2020). Implementing the monitoring mechanism guarantees precise evaluation, leading to prompt modification and optimization of the intervention.
The selected components offer the desired patient outcomes since they are carefully designed to optimize care coordination and enhance workflow from a multidimensional approach. For instance, training empowers practitioners to comprehend and focus on the necessary procedures, whereas enhanced communication streamlines care coordination between professions. This monitoring process facilitates continuous quality improvement, ensuring sustainability and adaptability.
The population segment under investigation consists of elderly individuals from varied cultural backgrounds. Language limitations or cultural preferences may impede patients' ability to make informed health choices. Moreover, cultural attitudes towards growing older and medical care may shape their beliefs regarding the necessity of prompt intervention. The ER department also has a distinct cultural identity, with medical specialists often working under high pressure (Erickson, 2020). The potential effects may influence how interventions are carried out, as customized approaches should be designed to cater to the distinct requirements and complexities present in emergencies. Collaborative care in such an environment requires efficient communication mechanisms between diverse medical personnel.
Cultural needs and characteristics influence the development of the educational program. Cultural sensitivity should be incorporated into the content creation process, considering varied patient experiences and worldviews to facilitate engagement (Wenk and Frey, 2021). Similarly, adjusting communication techniques to cater to individual language choices and cultural standards can foster efficient teamwork.
The cultural characteristics of the emergency department setting emphasize the need for clear and concise communication methods due to the fast-paced nature of care. These intervention components must complement these qualities to prevent disruptions in the workflow. Strategies, including dynamic workshops and brief educational materials, are tailored to the environment's efficiency and effective communication needs.
Theoretical Foundations
These nursing models serve as useful frameworks for our intervention plan. For instance, the Health Belief Model can be integral in the design by emphasizing the advantages of conforming to the protocol. Similarly, incorporating the Transtheoretical Model enables the development of patient-centered interventions based on their readiness to embrace change. The nudge theory, based on behavioral economics strategies, relies on subtle cues to influence decision-making processes. These strategies can influence the design by incorporating prompts and reminders within the communication process to alert physicians toward emergency protocol initiation.
Modern communication methods, including messaging and telehealth systems, can significantly affect intervention plans (Zhang et al., 2022). Streamlining communication across teams and enabling virtual assistance to enhance consultations.
These models provide an understanding of how patient and provider behavior are intertwined. Integrating the Health Belief Model emphasizes the importance of urgent action and its positive impact on motivation among both patients and doctors. On the other hand, the Transtheoretical Model enables personalized interventions by leveraging the monitoring and evaluation mechanism, which develops patient-based interventions based on the patient's degree of readiness.
Stakeholders, Policy, and Regulations
The relevant parties for this initiative are geriatric patients, emergency department doctors, orthopedic surgeons, cardiologists, anesthesiologists, nurses, hospital leaders, and patient advocacy organizations. The requirements of these parties will influence the development and execution of intervention plan aspects.
Timely responses and comprehensive care are crucial when addressing the healthcare needs of the elderly. Physicians in the ER department require flawless communication channels and informational tools to maintain compliance with recommended procedures (Tran et al., 2021). Orthopedic surgeons need optimized communication channels to coordinate care with the rest of the healthcare staff. Nurses require efficient communication and educational support to facilitate collaboration. Hospital management endeavors to apply cost-efficient methods to meet regulatory demands. These groups push for measures that safeguard patient welfare and promote quality care.
Crucial policies regarding emergency interventions, surgical treatments, and patient protection are relevant. The policies under consideration influence the quality of care, timely interventions, and collaboration among teams, ultimately determining the intervention strategy's different components.
The policy framework sets forth principles for prompt interventions, collaborative effort across departments, and patient-focused care. Compliance with the rules facilitates uniformity among intervention methods. Patient-focused rules, consent standards, and interprofessional cooperation are vital. The rules outline the moral and legal implications of designing the intervention framework (Wang & Seibel, 2023). Legal requirements are embedded within healthcare regulations to guarantee ethical standards. Directions on patient agreement, discussion facilitation, and joint engagement shape the formation of educational programs, communication methods, and consultation practices.
Government agencies also involve various professional nursing associations, institutions, the Joint Commission, and the Centers for Medicare and Medicaid Services (CMS) (Swenning et al., 2020). These bodies set parameters for the healthcare sector through their guidelines. These governing agencies ensure the integrity of medical practice. The governing rules and accreditation standards influence the structure of treatment plan segments, ensuring patient care and adherence to industry-wide standards.
Ethical and Legal Implications
Some key ethical concerns in this project involve safeguarding patients' rights, obtaining their consent, offering accessible care, and meeting the requirement of delivering suitable treatments promptly. These ethical concerns will impact healthcare practice, organizational change, and specific intervention plan components. By putting autonomy first, providers foster trust and respect in ...