I read with great interest 'Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network' 1 and the response article 'Proximal femoral fracture; an acute emergency? ' 2. I agree that patients who present with proximal hip fractures should be treated on an urgent basis, in order to reduce morbidity and mortality.
These patients are elderly, frail and have multiple co-morbidities. Prolonged immobility caused by the proximal femoral fracture lead to an acute deterioration of the patient due to chest infection, thromboembolism, altered mental state etc.Thus, these patients need to be attended and treated without delay to prevent any increase in their morbidity and mortality.
In our hospital, we have 11 dedicated trauma sessions per week; 2 sessions per day on weekdays, and one session on Saturday mornings. In an attempt to prevent the delay in treating these patients (especially during the weekends), the first patientwith proximal femoral fracture scheduled for surgery the next day is referred to the anaesthetist on the night before surgery. The anaesthetist will review the patient and offer an opinion regarding whether the patient is fit for theatre. The patient will be optimised overnight and undergo the necessary investigations. The main aim being that the patient is ready for surgery the next morning.
An observational study conducted at the Heart of England Foundation Trust in 2006-07, on ‘The impact of Physician Assistants in trauma theatre efficiency’ showed that the presence of physician assistants improves the ability to start the list on time, improves the number of cases done over the weekend and also the combination of a consultant and a physician assistant improves efficiency.
Therefore, I put forward these two recommendations, as a means to treat patients, who present with proximal hip fracture, more effectively and efficiently.
Dr M Lohit
Northampton General Hospital, Northampton,
E-mail: lohitm69@googlemail.com
References:
1. White SM, Griffiths R, Holloway J, Shannon A. Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network. Anaesthesia 2010; 65:243– 248.
2. McAfeeS.http://www.respond2articles.com/ANA/forums/464/ShowThread.aspx#464 (accessedon24.03.2010)