Improving Care for Our Hip Fracture Patients: A Physician Quality Improvement Project

Each year, approximately 300 people arrive at Providence with fractured hips. These patients are often elderly, frail, have multiple comorbidities, and pre-operative pain is typically managed through intravenous opioids, which can lead to delirium, decreased awareness and more medical complications.

There is strong evidence that if patients receive a pre-operative femoral nerve block, their pain will be dramatically reduced. Patients who receive this require much less opioid and have better pain control while they wait for surgery. Dr. Dr. Trina Montemurro has set-up a quality improvement project to develop and implement a pathway so that anesthesiologists can assess all hip-fracture patients and perform a femoral nerve block if appropriate as soon as these patients are admitted. This requires the involvement of many health care providers: emergency medicine, orthopedics, anesthesiologists, internal medicine and the acute pain service. Additionally, our emergency and ward nurses need to be involved and aware of the nerve block.

So far we have successfully begun to perform nerve blocks on many of our hip fracture patients and are assessing for decreases in opioid consumption and other complications. Although the pathway is in its infancy stages, it is gaining traction and we are hearing about great successes from individual patients.

Physician Led Quality Improvement (PLQI) is a quality improvement partnership among VCH, Providence and Specialist Services Committee (SSC) to strengthen the quality improvement capacity and culture within our physician community. Work is done collaboratively with Quality department colleagues and help physicians connect with operations and gain support from senior leadership.