liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Unpacking the key components of a programme to improve the timeliness of hip-fracture care: a mixed-methods case study
Karolinska Institute, Sweden.
Karolinska Institute, Sweden.
Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.ORCID iD: 0000-0003-4730-5453
Karolinska Institute, Sweden.
Show others and affiliations
2015 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 93Article in journal (Refereed) PublishedText
Abstract [en]

Background: Delay to surgery for patients with hip fracture is associated with higher incidence of post-operative complications, prolonged recovery and length of stay, and increased mortality. Therefore, many health care organisations launch improvement programmes to reduce the wait for surgery. The heterogeneous application of similar methods, and the multifaceted nature of the interventions, constrain the understanding of which method works, when, and how. In complex acute care settings, another concern is how changes for one patient group influence the care for other groups. We therefore set out to analyse how multiple components of hip-fracture improvement efforts aimed to reduce the time to surgery influenced that time both for hip-fracture patients and for other acute surgical orthopaedic inpatients. Methods: This study is an observational mixed-methods single case study of improvement efforts at a Swedish acute care hospital, which triangulates control chart analysis of process performance data over a five year period with interview, document, and non-participant observation data. Results: The improvement efforts led to an increase in the monthly percentage of hip-fracture patients operated within 24 h of admission from an average of 47 % to 83 %, with performance predictably ranging between 67 % and 98 % if the process continues unchanged. Meanwhile, no significant changes in lead time to surgery for other acute surgical orthopaedic inpatients were observed. Interview data indicated that multiple intervention components contributed to making the process more reliable. The triangulation of qualitative and quantitative data, however, indicated that key changes that improved performance were the creation of a process improvement team and having an experienced clinician coordinate demand and supply of surgical services daily and enhance pre-operative patient preparation. Conclusions: Timeliness of surgery for patients with hip fracture in a complex hospital setting can be substantially improved without displacing other patient groups, by involving staff in improvement efforts and actively managing acute surgical procedures.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2015. Vol. 23, no 93
Keyword [en]
Hip fracture; Process improvement; Quality improvement; Timeliness; Case study; Statistical process control charts
National Category
Health Sciences
URN: urn:nbn:se:liu:diva-123807DOI: 10.1186/s13049-015-0171-6ISI: 000365486700001PubMedID: 26552579OAI: diva2:892914

Funding Agencies|Swedish Vinnvard Research programme

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2016-02-17

Open Access in DiVA

fulltext(1423 kB)25 downloads
File information
File name FULLTEXT01.pdfFile size 1423 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Elg, Mattias
By organisation
Logistics & Quality ManagementFaculty of Science & EngineeringHELIX Vinn Excellence Centre
In the same journal
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 25 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 80 hits
ReferencesLink to record
Permanent link

Direct link