Improving Access to Rehabilitative Care for Hip Fracture Patients: Bridging Acute Inpatient Care at TOH to Geri Rehab at Bruyere
Quality Improvement & Outcomes
Hip fractures represent sentinel events in the health trajectories of frail and chronically ill individuals, often precipitating a steep functional decline and sometimes causing permanent disability. Best practices indicate that hospital care pathways should adopt the goal of active rehabilitation starting no later than six days after a patient’s hip fracture surgery. Given the complexities of hip fracture management during care transitions, our research’s overall purpose was to develop and implement a theory-based intervention for an earlier discharge of the geriatric hip fracture population transitioning from acute care to subacute care.
This study identified key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of an intervention aimed at improving access to rehabilitative care for hip fracture patients.
Background: We are increasingly moving towards better system integration to improve the quality of care for hip fractures throughout the continuum of their recovery. The purpose of this study was to describe the barriers and enablers to the implementation of best practices for the management of hip fracture patients transitioning from acute care to subacute care.
Methods: We conducted a qualitative descriptive study consisting of semi-structured interviews with geriatric hip fracture patients (n=8), caregivers (n=1), administrators (n=12), and clinicians (n=17) on two orthopaedics units and on a geriatric rehabilitation service.
Results: The clinicians’ top barriers were: 1) competing demands (n=24), 2) lack of bed availability, community resources, and funding (n=19), and 3) need for extended hours and increased staff (n=16). The top 3 enablers were: 1) clear communication with patients (n=27), 2) benefits of geriatric rehabilitation (n=24), and 3) need to receive education and resources in order to properly use the pathway (n=15). Common barriers among patients and caregivers included: 1) lack of care coordination, 2) overcoming some of their own specific challenges during their transition, 3) gaps in the information they received prior to discharge, 4) not knowing what questions to ask, and 5) lack of resources. Despite these barriers, patients were generally pleased with their transition.
Conclusion: This study identified key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of an intervention aimed at improving access to rehabilitative care for hip fracture patients.
Our next step is to develop an evidence-based intervention for the implementation of best practices for the management of hip fracture patients transitioning from acute care to subacute care. This will include consultation meetings with key stakeholders to select the intervention strategies based on the key barriers and enablers identified in our study. We will then select the evidence-based behaviour change techniques (BCTs) that address these barriers and enablers, and combine techniques into a deliverable intervention that will be evaluated in a randomized trial for feasibility and acceptability
Backman, C., Harley, A., Papp, S., French-Merkley, V., Beaulé, P. E., Poitras, S., Dobransky, J., & Squires, J. E. (2022). Barriers and Enablers to Early Identification, Referral and Access to Geriatric Rehabilitation Post-Hip Fracture: A Theory-Based Descriptive Qualitative Study. Geriatric Orthopaedic Surgery & Rehabilitation, 13, 21514593211047666–21514593211047666. https://doi.org/10.1177/21514593211047666