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“Code Hip” program shaves hours off hip fracture surgery wait times

Toronto, April 25, 2013

By Emily Holton. Photos by Katherine Cooper

Jane Hume (operating room nurse),  Dr. Nick Lo (anesthesiologist) and Rose Cabacungan (clerical assistant, OR) check the urgent surgery list, watching for “Code Hip” patients who must reach the OR within 48 hours of arrival.
Jane Hume (operating room nurse), Dr. Nick Lo (anesthesiologist) and Rose Cabacungan (clerical assistant, OR) check the urgent surgery list, watching for “Code Hip” patients who must reach the OR within 48 hours of arrival.

Lisa Wild, CLM in Perioperative Services, describes the Code Hip program as “a hit!”

The driving force behind St. Michael’s steadily improving wait times for hip fracture surgery, Code Hip is a collaboration between the Emergency Department, Perioperative Services, Orthopedic Surgery, Anesthesia and Internal Medicine.

“Our goal was to get patients into surgery within 48 hours of arrival to Emergency,” Wild said. “A couple of years ago, that was only happening for about half of our patients, so we decided to initiate a new care pathway based on the national model of care for hip fractures.”

All the services involved got together to map out the process and talk it through. Wild attributes the success of the initiative to this initial groundwork – up-front communication as a group and one-on-one.

When the nursing triage or ED physician call a Code Hip, they make sure they triage and assess the patient within one hour of the patient’s arrival in the ED. At the same time, the orthopedic team immediately books the patient on the “urgent” list for surgery, ensuring that the patient is scheduled to reach the OR within 48 hours of arrival. If an anesthesia or internal medical consult is required, these groups prioritize the patient so they’re seen as quickly as possible. Any essential tests are fast-tracked and non-essential items are delayed until after surgery.

A “Code Hip” decision tree for residents and surgeons to carry with them.
A “Code Hip” decision tree for residents and surgeons to carry with them.

When elderly people wait more than two days for hip fracture surgery, their risk of dying increases. Cognitive problems such as delirium, depression and dementia are more common and rehabilitation after surgery tends to be less successful.

In March, the Canadian Hospital Reporting Project reported that St. Michael’s rate of performing surgery for hip fractures within 48 hours of arrival to hospital jumped from 55 per cent in 2009-10 to 75 per cent in 2011-12 (Code Hip’s first year in action).

“Not everyone is a candidate for fast-tracking to hip fracture surgery,” said Wild. “But we’re hitting our target with almost all of the rest. Within two or three months of launching it, Code Hip felt like a standard practice. It’s worked really well.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.